


Medical Insult

by DiamondBlue4, InhoePublishing



Series: Academy Years - Juncture Point [1]
Category: Star Trek: Alternate Original Series (Movies)
Genre: Academy Era, Allergies, Gen, Hurt/Comfort, Injury, Medical Procedures
Language: English
Status: Completed
Published: 2020-05-03
Updated: 2020-05-23
Packaged: 2021-03-02 09:08:31
Rating: Teen And Up Audiences
Warnings: No Archive Warnings Apply
Chapters: 7
Words: 45,565
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/23968876
Author URL: https://archiveofourown.org/users/DiamondBlue4/pseuds/DiamondBlue4, https://archiveofourown.org/users/InhoePublishing/pseuds/InhoePublishing
Summary: Kirk get injured during maneuvers at the end of the first year of the Academy, but when he has a severe allergic reaction to the medications, it's McCoy who must find a way to save him. Meanwhile, Pike keeps a careful eye on Kirk as things get worse.“You’re okay, Jim. You had an allergic reaction to some of the medication we gave you,” McCoy said deliberately, watching Jim’s reaction, looking for a sign that Jim was comprehending. “Your airway is still swollen, so try and let the machine breathe for you.”
Series: Academy Years - Juncture Point [1]
Series URL: https://archiveofourown.org/series/1953835
Comments: 119
Kudos: 203





	1. Chapter 1

**Author's Note:**

> Co-written by DiamondBlue4. My first co-written and Academy story. We hope you enjoy our version of year-one in the Bones and Kirk saga.

**Starfleet Academy Medical Center**

Stardate: 2256.05

McCoy leaned back in the narrow chair at the intake desk at Starfleet Medical and forced himself not to let his eyes close. I should go into the lounge, he thought, coffee up, relax. He looked around the empty emergency room. The last patient had been discharged an hour ago.

Tam, the newest intern, leaned against the desk where the other nurses were congregating. “Man, it’s slow.”

A round of moans and curses followed.

“Don’t say that,” Ci, the ER nurse said. “We got three more hours and I have a date tonight with my five-year-old. I want to be home on time. For once.”

“Not gonna happen now,” Kelli said, shaking her head. “Tam just jinxed us.”

“There’s no such thing, you know,” Tam retorted. “The scientific community debunked that idea years ago. Same with believing full moons cause people to act crazy.”

“Live and learn, grasshopper,” Kelli admonished. “And don’t come crying to me when you’re up to your elbows in blood and guts.”

“Well, there’s not a lot of time left on this shift to prove me wrong,” Tam said, pointing to his chronometer.

McCoy tuned out the banter and leaned further into the cushions of the chair. It was rare he had the opportunity to sit when he was on shift in the ER. Saturday nights and leaves were the worse, bringing in a parade of drunken injuries.

The alert chime sounded, followed by a red flashing light, and Ci moved quickly to answer, giving Tam an annoyed look.

“We’ve got one coming in. Level 3,” she said, staring down at the PADD in her hand. She glanced up at Tam. “I hope you’re happy.”

Tam pretended to duck, throwing up his arms as if to ward off a blow, as McCoy glanced up. It had been a long and boring twelve-hour shift, one filled with sprains, fevers and the dreaded and irritating “something doesn’t feel right”. He wanted a shower, a good meal that wasn’t replicated and three fingers of his twelve-year-old bourbon, straight up. But of course, that was too much to ask, since they now had a Level 3 case coming in. He’d be lucky if his shift ended on time at this rate.

“Make that two,” Ci amended. “One twenty-three-old male with a laceration to the upper thigh.” She frowned. “Looks like they had trouble controlling the bleeding in the field.”

Of course, they did. Medics were all adrenalin junkies, reveling in the triage and pretending to be doctors. Most of the time they’d transport an injury like that with a half-ass wrapping leaking blood and inadequate fluids infusing through a small, eight gage catheter. Christ. McCoy stood up from the terminal and stretched, feeling his spine pop.

“Male number two is twenty-five, suspected torn knee and hip ligaments, and…” Her eyebrows rose. “Compound fracture of the radius and ulna.”

McCoy got to his fee, instructing the team to prepare two beds in the trauma bay.

“Where’s he coming in from?” Kelli asked, eyeing Tam, the intern, with a faux-innocent expression. There’d been a flurry of activities— intravenous bags and lines prepped and hanging, scanners turned on and left in Standby mode, and the convenient placement near to hand of the usual instruments and equipment routinely used on all trauma patients— and now they were just waiting for the patients themselves to arrive.

“Maneuvers,” Ci said.

“I told you,” Kelli said in a sing-song tone, looking back at the intern.

“Yeah, yeah.”

As they moved to their places, McCoy tried to ignore the habitual mindless banter between Kelli and Tam. Today’s bone of contention had been a bet— not to go to end of shift without a patient arriving from maneuvers. Now Kelli had just won.

“It always happens on the last day. It’s the big finale,” Kelli said. “Cadets smell the finish line and are determined to complete it. At least one of them is gonna do something desperate— and stupid.”

It was the end of the academic year for the Academy students and that meant it was the time for the annual combat maneuvers for the Command and Security track cadets. The grueling course had been going on for the past two weeks, and culminated today, the final day of the intense program. It was a program that had historically produced a constant stream of minor injuries. This year had been no different and treating the resulting injuries had kept the ER busy all week as the cadets pushed to complete the program to claim the honor of their damn combat badge.

Idiots.

Even his best friend, Jim, had gotten caught up in the competitive atmosphere. Though Jim was a first-year cadet, he’d been accepted into the course because he was top of his class— in everything. He had the highest ratings of any cadet in the history of the academy – except for some Vulcan, who also had the cachet of being the only Vulcan to graduate from Starfleet Academy. It was Captain Pike who had granted Jim’s request, and the kid’s ego had swelled even more than usual. Jim would be the only first-year cadet to complete the course. They planned to celebrate his accomplishment tonight.

_“This is it,” Jim said with a look of eagerness. “Final day.”_

_McCoy had come out to the commons to see Jim off on today’s last round of challenges. His friend stood with his gear at his feet, waiting with the other cadets for their pickup. Ten days ago, the group had been enthusiastic, bright-eyed, eager and optimistic. Typical young lions ready to take on the world. Now they stood nervously, shuffling their feet, flinching at any unexpected noises, and, in general, looking like they were lining up for a firing squad. Except for Jim, of course, who stood with quiet confidence. McCoy scrutinized his young friend’s face, noting the finely drawn lines of fatigue around the kid’s unusually bright blue eyes._

_“You look tired,” McCoy commented._

_Jim nodded. “I’m going to sleep for a week when this is over.”_

_And he could for once, because the year-end break was scheduled to begin in twenty-four hours. They both were looking forward to some well-deserved downtime. Jim pushed a hand impatiently through his hair and stretched his neck. It had been a tough week and Jim was pushing himself to not only finish the course, but to set a record doing it._

_“You know, if you don’t complete the course, there’s always next year.”_

_Jim gave him an incredulous look. “Thanks for the pep talk, Bones.”_

_“Fifty percent don’t make it,” McCoy reminded him._

_“Are you trying to get out of our bet?”_

_McCoy gave him an affronted look. “A McCoy never welshes on a bet.”_

_But the fact remained, the final day was where the majority of the cadets failed out. McCoy had a suspicion Starfleet had designed it that way— cull the unqualified before they could do any harm in the future. Few who failed tried a second time. It was a grueling course, unrelentingly demanding both physically and mentally, a course which required split-second decisions and reactions. There was a good reason it was usually reserved for second-year cadets. While Jim wasn’t much younger, age-wise, than the other cadets in the course, he lacked the benefits of a second year of Academy training._

_“That’s me,” Jim said, picking up his duffel as the sound of the hover transport filled the air. He gave McCoy a determined nod._

_“Keep your head down, kid.”_

_“I got this, Bones.” Jim grinned. “I’m going to break the record and you’re going to buy my drinks tonight.”_

_For someone going off to combat maneuvers for the fourteenth day in a row, he was damn happy._

_McCoy sighed, watching as Jim climbed eagerly aboard the transport and disappeared from sight. He had a twelve-hour shift at the hospital starting in an hour. Meanwhile, Jim would be climbing through an expertly rigged obstacle course with a hundred other over-eager, trigger-happy cadets._

_For once, he had the better deal._

McCoy glanced at his chronometer impatiently. Jim was probably close to finishing as he stood here waiting for the medical transports to arrive. In less than an hour, Jim would be done, ready to celebrate. McCoy just hoped whatever was on its way in wouldn’t hold him up past the end of his shift. Because, while the kid drank like a fish and the victory party was going to cost him a week’s pay, he was, truth to tell, looking forward to celebrating Jim’s accomplishments.

A laceration didn’t sound too bad, if it wasn’t deep, and the medics had given it proper care. Probably some over-eager, trigger-happy cadet had sliced their damn leg trying to outdraw the ‘enemy’. Most of the injuries he’d seen over the past two weeks were soft tissue injuries or superficial abrasions, easily treated at the field clinic; medical protocol, however, required a Starfleet General physician to provide a final exam and sign-off. The injuries of the two incoming cadets were more serious than that, which put them in McCoy’s lap from the outset.

He stood in the receiving bay with his team and tried to quell his impatience. He’d been with the Academy for a full year. As a trained surgeon, he’d been put to good use in the hospital, and rotated through ER, surgery and clinic duty, as well taking Starfleet fundamentals with every pimply-faced, eighteen-year-old cadet. Before Starfleet, he’d been regarded as the best trauma surgeon at Atlanta Central, had dined with the upper echelon, and treated some of Earth’s more elite. Now he was sleeping in a one-room dorm, standing in line to eat with a thousand other Starfleet recruits and treating injuries on cadets not old enough to drink.

The light above the bay entrance flashed, indicating the arrival of the transport. He took a moment to survey the big, semicircular room. All the beds were empty. Their last patient had been released an hour ago. At least he didn’t have to worry about capacity, as had been the case when the Andorian Flu had hit last semester. They’d had to bring in mobile beds and had patients lining the hallways. He could still smell the sour odor of vomit.

The doors swooshed open.

“—this fucking thing off me.”

McCoy’s head snapped around as he instantly recognized the voice. He gazed disbelievingly as a highly agitated Jim Kirk was wheeled in on a gurney.

“That “fucking thing” is keeping you from bleeding to death, Cadet,” the medic said, matching Jim’s tone. The man had a firm hold of Jim’s wrist, presumably to keep Jim from disturbing the cuff on his thigh.

Right behind Jim was another gurney containing a moaning cadet who was far less combative.

“What happened?” McCoy demanded, stepping to the side of Jim’s gurney, which had come to a halt just inside the doors. He cast an assessing eye over Jim and it was clear at a glance the kid was in shock. Jim was profoundly pale, breathing rapidly, and tremors raked his body head to toe. There was blood everywhere, on Jim’s hands as well as on the legs of his fatigues, and the pressure bandage surrounding his left thigh was bloody, as well. The thickly inflated material was only used to stop severe blood loss— which meant, more than likely, that an artery was involved.

“Hero here got knifed by his own equipment,” the medic said. “Laser combat knife sliced right through his quad.”

Jim’s bloody hands curled into fists, as he tensed in fury. “I didn’t get hurt by _my_ knife, asshole. It was Grady’s knife; he didn’t have the fucking safety on!”

“You still got knifed,” the medic shot back, unfazed by Jim’s fury. He didn’t loosen his grip on Jim’s wrist, however, as he addressed McCoy. “This idiot wants to go back to the fun and games. He’s already tried to remove the cuff twice enroute.”

“Take it easy, Jim.” McCoy put a hand on Jim’s arm, hoping to steady and calm him. He could feel the fine tremors tearing through Jim’s frame. He squeezed the flesh of Jim’s arm a little more firmly and felt the young man’s tension slacken. There was a lot he wanted to ask Jim, and even more he wanted to say to his friend, but now was not the time. “What are his vitals?”

“He’s shocky. BP 92/40, pulse 166 and thready, respirations 26. 92% oxygen saturation. It was difficult to start a line because his peripheral veins kept collapsing due to the blood loss but I finally got one inserted. It’s tenuous, though. Hung a liter of normal saline, and it’s running at 150.”

McCoy knew enough about Jim’s personality to know that pain and fatigue often made him belligerent, rather than subdued. Jim was a difficult enough patient, though, without adding an antagonistic medic to the mix. He looked at the medic and motioned to the beds along the wall. “Put him on two.”

“Gladly,” the man said, steering the gurney.

“Try not to kill me in the process,” Jim said to the medic.

Jesus, Jim could piss off a saint.

The second gurney followed. The young man was not obviously bleeding, which matched the report, but McCoy could see with one look that the bones of the right arm were broken— a compound fracture. A light brace stabilized the arm. The man’s hand was white, and he was clearly in pain.

“Severe break to the radius and ulna,” the second medic said. “There’s debris in the wound, and the ends of the bones are chipped. He’s a good candidate for a bone infection and non-union. BP 162/94, pulse 182, respirations 32. Left ulnar vein intravenous line started with normal saline hanging. He needs pain control right away.”

It annoyed McCoy when medics diagnosed. He shot a glaring look at the man and was about to say something when the pale-faced boy on the gurney moaned.

“Christ, my arm is fucking killing me.” Cadet Grady whined, looking at anything other than his broken arm.

“We’ll take care of you,” McCoy said calmly to the young man, then looked at the medic. “Bed three.”

McCoy hung back, letting his team oversee the transfers. The medic quickly— and none too gently— transferred Jim to the bio bed, eliciting a sharp cry of pain from him as his leg was roughly jostled.

“Take it easy there, medic!” McCoy admonished sternly.

Jim was right. The man was an asshole.

Both patients now on bio beds, the medics quickly exited the trauma bay, guiding their gurneys out. He’d deal with the arrogant one later, see that a reprimand was placed in his file. Right now, he needed to focus on his patients.

“Take the patient in three,” he said to Tam, nodding toward the other bed, as he stepped closer to Jim’s biobed. “Make sure the hand below the fracture is getting adequate perfusion. And give him something for pain after you check his chart. Once the scans are finished, call ortho. Sing out if you have any questions or run into trouble. And be sure to check his hip and knee ligaments, too, since the call stated there was suspected damage.”

Confidant that the intern could adequately handle his orders, McCoy turned his attention to Jim. The monitor above the bio bed lit up as Jim’s vitals were picked up by the sensors and displayed. McCoy studied the readings as Jim struggled to sit up.

“Get this off me, Bones. I need to get back out to the field. I’m not done with the exercise.”

McCoy dropped his gaze from the monitor to Jim and scowled. “You’re not going anywhere. Settle down, Jim. You’ve got a significant injury to your leg and we need to take a close look at you to be sure you aren’t injured anywhere else.”

“Yeah, Kirk,” came the angry retort from the other bed. “Listen to the doc. You’re not going _anywhere_ , you fucking glory hound.”

“Glory— You’re a clumsy ass, Grady!”

“Oh, right! I suppose you’re perfect?”

“Quiet, please, cadets, ” Tam said. “This is a hospital.” He gave Grady a stern look, trying to get control of the cadet.

“I’m not the one who fell into a ditch!” Jim shot back, ignoring Tam as if he were invisible.

“You fucking broke my arm.”

“After you fucking sliced my leg open! The instructors were really impressed with that move.”

“Calm down, Jim!” McCoy ordered. The overhead monitor began to blink yellow in several areas, a warning that Jim’s pulse and respirations were increasingly outside normal parameters. The medical staff was in motion around both beds, and this seemed to only further agitate the men.

“I need you stay still,” Tam said to Grady. “You don’t need to incur any more damage to your arm.”

“Start another IV line with normal saline,” McCoy ordered Ci.

“You weren’t even supposed to be in that ditch, hotshot! That area was off the course,” Grady fumed, ignoring Tam. He was craning his neck in an attempt to see Jim more clearly, since Tam had insinuated himself between the two beds, blocking Grady’s angry gaze.

“And you were supposed to have your weapon under control with the damn safety on!” Jim was shaking harder now, and his pallor had deepened. Despite that, he was struggling to sit up, all the while glaring at the other cadet. “Fucking amateur.”

“Jim, settle down!” McCoy said, stepping forward in an attempt to refocus Jim’s attention. “Run that IV wide-open, Ci,” he ordered, as Jim’s blood pressure began to blink in yellow.

“Fuck you, Kirk!”

“Right back at you, Grady!”

“Both of you shut up!” McCoy thundered, then met Kelli’s eyes and jerked his thumb at the divider.

Kelli immediately pulled the privacy curtain to separate the two men. McCoy hoped it would quiet them down. Tempers and pain were a bad combination.

Jim fell back against the surface of the biobed, panting. More than likely from exhaustion rather than cooperation, though. During the tirade, the nurses had gone about their business, quickly cutting off the rest of Jim’s clothes, their lasers slicing through the bloody material like it was old paper.

Everyone had a role during the first important minutes of receiving a trauma patient. Everyone on the team knew what to do and how to do it without being told. Priority number one was to get an unobstructed view of the patient’s entire body in order to determine the full extent of any injuries. They needed to have immediate access, without clothing in their way, in order to start intravenous lines, stanch freely bleeding wounds and identify any other critical injuries. The process wasn’t polite or respectful but it was necessary. It saved lives and preserved function while minimizing permanent damage. But that was cold comfort to the patient. McCoy imagined that, to Jim, it felt invasive, like he was being swarmed by a hundred unsympathetic hands.

In short order, Jim was rendered naked and shivering, his genitals covered by a thin white towel in a token nod to modesty. The only other item on his body was the pressure cuff around his thigh. Exposed and hurting, Jim twitched restlessly under the medical team’s ministrations.

“Give him 15ccs of Paradol,” McCoy ordered. Jim’s blood pressure was even lower than when he’d arrived, now that he wasn’t trading insults with Grady, and his respirations were increasing. The monitor indicated a high level of pain. It also reported he’d lost about two units of blood. “Call the lab and order a unit of packed cells to be delivered ASAP. Hang it as soon as it arrives. Tell them to prepare an additional two units and hold them. How long ago did this injury happen?”

Ci referred to the primary report. “Forty-five minutes.”

Christ! The morons in the field clinic had taken their sweet time before transporting Jim.

“It says he vomited and was combative,” she reporting, continuing to read.

From pain, likely. Idiots!

He leaned over Jim’s right side. The young man was still trying to lever up onto his elbows. He put a hand on Jim’s shoulder and pressed down to keep him from moving. The flesh beneath his hand was cool and clammy, and he could feel the muscles trembling. “Jim, you need to remain still and save your energy.”

Jim glared at him, the skin around his eyes and mouth pinched tight with pain. “Get this thing off my leg, Bones.”

“It stays,” he said firmly. “We’re going to start another IV, give you some blood along with the IV fluids. We need to get your pressure up, so lie back and relax.”

Despite the obvious pain and shock he was experiencing, Jim still struggled against McCoy’s restraining hand.

“I need to get back to the course, Bones. I need to finish.”

“You’re in shock, Jim, and you’re not thinking clearly. You’re not going anywhere, kid.”

Ci came up to the head of the bed with a hypo and pressed it to Jim’s neck.

“Fuck,” Jim said through gritted teeth, straining his head back against the pillow, trying to put some space between his neck and the hypo. “What the hell was that?”

“The medication Dr. McCoy ordered to treat your shock,” Ci said gently. “Just try to relax and let it work.”

“I don’t need any goddamn medication,” Jim snapped. His respirations were rapid and his pale lips were now tinged with blue.

“Yes, you do,” McCoy contradicted sternly. “Now lie still before you do any more damage to that leg. The scans are almost done.”

“I can’t do any more damage than Grady already did with his fucking, trigger-happy—”

“You weren’t supposed to be there, asshole,” Grady’s voice interjected from the other side of the curtain.

“And you were supposed to have the goddamn safety on!”

Enough of this. McCoy’s voice boomed across the treatment room. “If the two of you don’t shut up, I’ll sedate you both!”

His threat immediately silenced Grady, and even momentarily subdued Jim. It didn’t take long for Jim to start up on his familiar refrain, however.

“Take this thing off, Bones.” Jim moved restlessly on the stretcher, flexing his right leg as if he were going to try and sit up, while his fingers plucked at the edge of the pressure cuff.

“Not right now.” Patients in shock often fixated on non-essential details, voicing the same question or request repeatedly. He gently but firmly captured Jim’s hand and pulled it away from the cuff. It wasn’t possible for Jim to remove it. It was designed to stay in place, in order to keep constant pressure on any damaged arteries. He put a hand on Jim’s right leg and firmly pushed it back down to lie flatly against the surface of the biobed. “I need you to remain still, Jim.”

“Just wrap it up, Bones. I can still finish. I’ll be fine.” Once again, he tried to rise, and, once again, McCoy pushed him flat.

Jim was shivering constantly now and his body was taut with tension, which was no doubt adding to his pain. “It’s freezing in here.”

“Increase the biobed surface to 29 degrees Celsius.”

Kelli turned up the temperature setting on the bed to help combat the coldness of the room air.

“You should feel warmer soon, Jim.”

“Just give me a fucking blanket.”

“Sorry. No blankets for the time being.” He was walking a fine line as it was, trying to decrease Jim’s discomfort with the ambient temperature of the trauma room while, at the same time, not encouraging blood to pool in the peripheral vasculature, further lowering Jim’s blood pressure.

“Then let me out of here, if that’s the kind of shitty service you’re offering,” Jim said, and again tried to push off the bed.

McCoy kept a firm hand on Jim’s shoulder, holding him down. Jim was surprisingly strong, despite his injuries. He had to be exhausting himself with his stubborn efforts, but McCoy’s more immediate concern was not allowing Jim to do more damage to his leg. “Listen to me, Jim,” he said sternly. “You are not going back to maneuvers, you are not leaving this hospital and you will keep your goddamn ass in this bed or I’ll sedate you. Understand?”

“Fuck you, Bones,” he said petulantly, but stopped his struggles, collapsing exhaustedly against the bed.

McCoy let out a short breath and reached blindly for the PADD Ci was extending from the other side of the bed. Kelli was busy with preparations for placing the second IV in Jim’s left hand, which was still balled into a tight fist.

“I need you to relax your hand,” Kelli said, tapping his clenched fist.

“Don’t touch me,” Jim snapped. He jerked his hand from her grasp and attempted to shove it beneath his body, but his movements were clumsy and uncoordinated.

“Go further up the arm,” McCoy ordered, focusing on the report displayed on the PADD. “Restrain him at the wrist, if you need to.” They needed to get fluids into Jim and McCoy was done arguing. He frowned as he read.

The body scan showed a three-dimensional image of the wound, which was deep and long – over 10 inches in length. The laser combat knife had a thick ‘blade’ that projected over eight inches when activated. It was designed to kill— quickly and efficiently. Lucky for Jim, Grady’s aim had been off. The blade had cut into Jim’s quadricep muscle and nicked his lateral femoral circumflex artery. The medic was right, the cuff was keeping Jim from bleeding to death. But the artery was still leaking blood into the surrounding tissues, albeit very slowly, despite the pressure cuff. Damn it. He handed the PADD back and moved up into Jim’s line of sight. He looked down at the young man, still shivering and in obvious pain.

He turned to Ci. “Prepare 10 mg of Morphine in a hyposyringe, please.”

“I was a klik away from finishing, Bones.”

“I’m sorry, Jim.” He didn’t know what else to say. The command track was difficult and there were no exceptions granted to the curriculum requirements. Jim needed to finish combat maneuvers or take the course again in order to graduate from that track. And given the results of his leg scan, Jim’s only option now was to retake the course next year.

Ci handed over the loaded hypo and he pressed it gently to the side of Jim’s neck. For once, the kid didn’t object.

Kelli soon had the second IV line in place and additional fluids were running. Despite that, Jim’s vitals were still unstable. In the year he’d known Jim, he’d treated him for minor injuries, mostly cuts and sprains, and a few cracked ribs once, thanks to an over-zealous hand-to-hand practice session. Twice he had performed a closed reduction on Jim’s dislocated right shoulder. After the second intervention, Jim had guiltily admitted that it tended to occur when he recklessly stressed it. He had promised to be more careful in the future and McCoy had warned him that a permanent surgical fix would be necessary if it happened again. But this was the first time Jim had sustained anything that he would call a critical injury.

Resigned, he began to issue the necessary orders. “Ci, call the OR. Tell them we need a room, a surgical team and an anesthesiologist stat. Kelli, you call the blood bank and get six units of packed cells sent to the OR.” He looked down at Jim. The pain medication had begun to take effect. Jim was finally quiet and still, his face nearly the color of the sheet he was lying on. His shivering had stopped, though, and his respirations had slowed to something closer to normal. “Better?”

Jim nodded, but his eyes were angry. Ok, so Jim was pissed. McCoy sighed. “Listen, kid, you have a nicked artery in that leg and you’re going to need surgery. Now.”

“Fuck,” he said softly, and closed his eyes.

McCoy knew he had just sounded the death knell on Jim’s last hope of getting back to maneuvers. He put a hand on Jim’s shoulder and squeezed it reassuringly. “We’ll be moving you as soon as the OR is ready.”

“Are you doing it?” Jim asked suddenly, opening his eyes.

He looked at Jim, saw the worry and uncertainty in his friend, and shook his head. “No, Jim. I’m not on surgical rotation today. But there are several good vascular surgeons here on staff. You’re in good hands.”

“You do the surgery. Please?”

All the fight had gone out of him and he looked, McCoy thought, ridiculously young and vulnerable. “If that’s what you want.” 

“Yeah,” Jim said softly, closing his eyes again.

Jim’s trust was oddly touching.

Maybe it was his vulnerability. Always before, Jim had been alert and awake during treatment, and he’d secretly enjoyed the running commentary on his handiwork, liberally laced with compliments and unnecessary cautions, as Jim bitched about whatever situation had caused him to land under McCoy’s care. And without fail, when McCoy finished rectifying the damage, Jim would look at him, his blue eyes warm with gratitude and say, “Thanks, Bones. Don’t know what I’d do without you.”

And he’d be off, leaving McCoy to wonder once again how Jim Kirk, a man who hated doctors and avoided medical care like the Therbian plague, and himself, an impatient and embittered loner and physician, had become best friends.

“I’ll take good care of you, Jim. I promise,” McCoy said gruffly.

“Mmm,” he murmured, his exhaustion clearly visible.

McCoy studied the monitor again and frowned. “Open up both IVs, Ci. Let’s run the remainder of these bags in as quickly as possible and hang two more.” He needed to get more fluids in Jim, get his blood pressure up before they anesthetized him, if he could.

“OR’s ready,” Ci said. “And the first unit of packed cells is here.”

McCoy nodded. “Hang it now. Who did they say was scrubbing?”

“Dr. Tafal.”

“Notify him that I’ll be doing the surgery.” He thought a moment. “And let him know he’s welcome to assist.”

She paused for just a moment. “He’s not going to like that news,” she said, as if to remind him that this was the third time in the past four months he’d usurped Tafal as primary surgeon on a case.

And he could give a rat’s ass about the man’s opinions. Hospital politics was a game he refused to play. McCoy was within his rights, both as a fully qualified surgeon and one who was acceding to a patient’s— Jim’s— request. The fact that Jim had listed him as his primary physician only four months earlier just provided him firmer ground to stand on. Still, this decision wasn’t going to win him any new friends.

“Let’s move,” McCoy ordered briskly, shaking off his thoughts.

They disconnected the bed from the wall and guided it toward the door. Jim startled at the movement and McCoy patted his arm reassuringly.

“What’s wrong?” Jim asked. His blue eyes were dazed and unfocused, his words slightly slurred. The pain medication had clearly taken hold.

“Nothing. Everything’s fine. You’re okay. We’re taking you to surgery now.”

Jim frowned. “It’s not over?”

“No. You’re in the ER,” McCoy reminded him gently. “Remember?”

Jim’s lids were half-closed. “Yeah... Fucking Grady.”

Yeah, McCoy thought. Fucking Grady. He wanted to strangle the cadet himself after seeing the results of Jim’s scan. “Just relax, Jim. I’ve got you.”

They moved smoothly down the corridor and into the turbo lift. As the lift began to move, Jim roused again. Struggling to focus, he looked around in confusion.

“Where am I?”

McCoy squeezed his arm, hoping to ground him. “In the lift. You’re okay.”

“Is it over?”

It was in moments like this that McCoy was reminded of how damn young Jim was. “No. Don’t worry. It soon will be.”

“You’re doing it, Bones? Right?”

“Yeah, kid. I’m going to fix you up good as new. Now rest.”

“I’m not….” was all Jim managed before he was pulled under again by the medication. McCoy sighed, and brushed the hair off Jim’s damp forehead.

The doors to the OR department opened with a soft swoosh, revealing the sight of Dr. Tafal standing with his hands on his hips, looking pissed.


	2. Chapter 2

The surgery took three hours when it should have taken one.

 _Damn the field medics,_ McCoy thought irritably, as he redressed in clean scrubs. They had known the clock was ticking once they placed the pressure cuff on Jim’s leg. After two hours, permanent damage to nerve, muscle and tissue occurred if the pressure wasn’t released. They’d come perilously close to that mark by the time they got Jim prepped and the cuff safely removed in the OR.

Of course, Jim had contributed to the delay by being his quintessential self—fighting anyone and anything in an attempt to control his own destiny. According to the records, he’d been extremely combative in the field. Pain and shock only partially excused his actions. For a genius, he could make some piss-poor decisions.

As a result of the delay, the tissue around the deep gash was profoundly swollen. When the circulating nurses had removed the cuff, the lacerated artery had opened further, causing a spurting wave of bright red blood to obscure his view of the surgical field. The next few minutes had been nerve-wracking, as Jim’s life blood soaked the table and dripped onto the floor. He’d placed instrument after instrument, until the pulsing flow finally slowed, then stopped, the hemostatic clamps controlling the bleeding bristling like the quills of a porcupine from the length of the wound. The surgical repair to Jim’s lacerated quadricep had required some tricky maneuvering to keep the surgical field clear. And even when he gained good control of what seemed like a thousand tiny bleeders, it had been a slow, tedious process to mend the arterial tear, reconnect severed nerves and the vascular network, before painstakingly coaxing the layers of muscle and tissue back into their normal positions.

His surgical gown had been soaked with blood and sweat by the time he finished closing. Exhausted and relieved, he had stepped back from the table on stiff legs. 

Jim had been lucky, though he doubted his friend would feel the same way.

A short while later, redressed and with a bottle of water in hand, he approached the circulation desk in the post-op ward. “You still here?” Helen asked. “I thought you’d be off duty and headed for home by now, after writing his admit orders earlier.”

It was 20:08. He and Jim were supposed to be raising glasses at Armed, a local bar most of the Academy cadets frequented. He should have been trying to slow down Jim’s celebratory drinking. Instead, Jim was facing a significant recuperation from almost bleeding to death after getting stabbed by a fellow cadet and, as a result, failing out of the most critical course in his track. Still in recovery, Jim hadn’t woken up yet. That wasn’t surprising, given Jim’s blood loss and the length of his surgery, but he needed to know his friend, now his patient, was all right. He didn’t care what time it was; he wasn’t going anywhere until he was sure Jim was okay and settled for the night. He already felt guilty for taking the time to grab a shower and a cold drink.

“Just keeping an eye on Cadet Kirk,” he supplied.

“He’s in bed four.” She motioned with her head, typing something into the main screen.

The recovery area was designed much like the trauma bay in the emergency room. It was a large open room, with the patients’ beds lined up in a half circle, like the spokes on a wheel, across from the circulation desk. There was minimal-to-no privacy for the patients. It was intentionally designed that way, in order to give the medical personnel a clear view of everyone at all times.

Post-op was a parking lot of sorts. Usually, patients didn’t stay long. They arrived fresh from the OR and stayed there until they woke up and were judged to be stable. Their respiratory status was closely monitored, since anesthesia was a respiratory depressant. It often took up to an hour for patients to become alert enough to no longer need supplemental oxygen. But once their vital signs were within normal parameters, they were moved, depending on the type of surgery they had undergone, to the appropriate floor, for the remainder of their convalescence. Jim would be an inpatient on the general surgery floor for a few days, at the very least. Even after discharge, there would be activity restrictions and physical therapy.

Jim wasn’t going to be happy. He had planned on leaving the Academy during the long summer break, intending to relax and blow off some steam. Physical therapy wasn’t going to be on his list of preferred activities.

McCoy looked toward the area Helen had indicated and immediately recognized the figure lying in the bed. It was oddly unsettling to see Jim so still.

“I heard someone stabbed him with a combat laser-knife?”

He nodded, rubbing his hand along the back of his neck, trying to ease some of the stiffness caused by the tense hours bent over the surgical table. While he’d taken the world’s quickest shower, he desperately wanted some food and a shot of that bourbon he had in his cabinet. Followed by about eight hours of sleep.

“That’s a new one,” Helen said. “A knife seems pretty up close and personal. What does the other guy look like?”

“A broken arm,” he replied. “Compound fracture of the ulna and radius.”

Helen looked surprised. “That kid? He looked like the type who’d be afraid to kill a bug, much less knife someone. We sent him up to the Ortho floor for an additional session with the bone regenerator about an hour ago.”

“No complications with the bone repair?”

“Nothing. Dr. Tam said everything went smoothly and they were planning on discharging him when the regen treatment was completed.”

“That’s good news, Helen. Thanks for the update,” McCoy said, and setting his water bottle on the counter for the time being, stepped away from the desk. Walking quietly to Jim’s stretcher, he picked up the PADD resting in its holder and walked further into the shallow alcove.

Jim lay utterly motionless, and it took McCoy a moment to detect the shallow rise and fall of his chest accompanying the concomitant beep of the monitor. Jim was still alarmingly pale, despite the amount of blood he had received. His right hand rested across his flat abdomen. An infusion pump controlled the IV line steadily infusing fluids, along with the last unit of packed cells McCoy had ordered, into a vein in his forearm.

Another intravenous bag containing a solution of salt and sugar and electrolytes hung on its own pump, the intravenous tubing connected to the central line they’d placed in the OR when it looked like Jim was about to bleed out. The colored lights on the infusion pumps blinked with each drop of fluid falling past their electronic eye. Beneath them, Jim lay unmoving, like a roughly handled gift abandoned beneath a grotesque Christmas tree.

McCoy was struck by the stark difference between the belligerent, combative man who had entered the ER only hours earlier and the unconscious one before him. All energy and vitality were gone from Jim, washed away in the copious amount of blood had had lost. An oxygen nasal canula was fitted beneath his nose, its telltale presence speaking volumes about Jim’s continuing need for respiratory support.

Habit swung his gaze to the monitors above the stretcher. Jim’s blood pressure was still too low. By contrast, his respirations were elevated despite the oxygen being supplied, and his O2 sats remained depressed. Jim’s pulse and temperature were within acceptable parameters, however, about what he would expect for a patient coming out of this type of surgery. But, with blood and fluids and oxygen being administered, those other troubling stats caused McCoy to feel uneasy. Clearly, Jim’s body was still struggling to find its natural equilibrium.

He glanced at Jim’s left leg. It was heavily bandaged beneath an ice pack, and slightly elevated to reduce swelling. The muscle had been severely damaged by the laser-knife, requiring countless delicate stitches to repair it. Beneath the bandage the thigh was bruised and swollen. Jim was going to be as sore as hell when he woke up. Which should be any time now, McCoy thought, checking his watch, making a mental note to closely monitor Jim’s pain levels. Jim never wanted to admit he felt pain, as if denying it existed made him impervious to the consequences of his injuries.

With a heavy sigh, he turned his attention to the chart in his hands. He’d been waiting on the results from the culture and sensitivity screen they’d sent to the lab. He was annoyed to see the results hadn’t come in yet. Damn it all. He was going to have to call the lab and find out what the holdup was. While the wound had been clean, with no obvious debris, Jim’s leg had reportedly been open for more than twenty minutes on the dirty battlefield, leaving him at a high risk for infection. It was more likely than not that bacteria had entered the wound. He needed to get Jim started on antibiotics. And soon.

McCoy sighed. A broad-spectrum antibiotic would suffice, he knew, until he had the lab report. He grabbed the stylus and began making notes as Ryan, one of the recovery nurses, entered the small alcove on the other side of Jim’s stretcher.

“I didn’t know you were still here, Dr. McCoy.”

He ignored the comment and looked up briefly to acknowledge Ryan, who was carefully checking the infusion pumps on the IV lines. Apparently satisfied, he moved on to the oxygen regulator.

“This is number seven, right?” Ryan asked, touching the nearly empty unit of blood.

“Yeah,” McCoy replied absently, his focus on the chart as he reviewed Jim’s medical history for any drug allergies. Satisfied that the single drug listed was one he could easily avoid, he said to Ryan, “As soon as that’s finished, start him on 1000 mg of Cephalazen IV and a pain med drip of 3 mg of IV Morphine every hour. I want to be notified immediately if that doesn’t keep him comfortable. And check with the lab. We should have had those C&S results by now.”

“Yes, Doctor.”

As Ryan left to comply with his orders, he looked around for a chair. The insistent ache in his back reminded him it was past time to take a break. He’d been so intent on Jim’s leg, he’d forgotten to stretch at intervals during the stressful surgery. Vascular surgery was delicate and intense at the best of times, and when Jim’s artery had opened up—

“Doctor McCoy.” It was Tam, appearing from nowhere and looking disgustingly refreshed and alert. “I’m glad you’re still here. Do you have a minute?”

McCoy suppressed a sigh. The chair would have to wait. “What is it?”

“It’s about the other cadet, sir. He’s ready for discharge.”

“Who?” McCoy asked, the majority of his attention still on Jim. Jim would be waking shortly, and he wanted to be here when he did.

“Cadet Grady. From the ER. The cadet with the compound fracture.”

Right. Fucking Grady. The cadet who had sliced through Jim’s quad. “Something wrong?”

“No, no problems, sir. He’s doing fine. I just need an attending to sign off on the discharge. Would you be willing?”

He looked back at Jim, still motionless. With a sigh of resignation, he nodded and followed Tam back to the circulation desk.

McCoy reviewed Grady’s chart. 30 cc of total blood loss during the surgery. The ligaments had been repaired and the fracture aligned and closed. Two rounds of osteo regeneration had been done. Antibiotics— He flipped to Grady’s medical history and quickly checked for any medication allergies. None. Reassured, he then flipped back to the discharge summary. Antibiotics had been ordered and a supportive brace placed on the arm. Off duty until reassessed in ten days. He would need rest, but there was no need to hold him in the hospital. Satisfied that all the bases had been covered, McCoy scrawled his signature on the release document.

Turning to give the chart back to Tam, he caught a flash of movement through the glass window in the door behind the circulation desk. A nurse entered, allowing him a brief glimpse of a patient seated in a wheelchair in the hallway. She walked straight towards him, smiling.

“Doctor McCoy,” the nurse said, “Cadet Grady would like to speak with you. He’s waiting right outside and says it will only take a moment of your time.”

Now what? He took a quick glance at Jim, but the kid was still unconscious. He handed the PADD to Tam with a nod. He didn’t want to leave Jim, but he was more than a little curious to find out what Grady wanted with him. He followed the nurse out the door. Cadet Grady sat in a hoverchair, looking sheepish and far more subdued than when McCoy had last seen him.

“You look better,” McCoy observed.

“I feel better.” Grady’s shoulders hunched defensively, as if he expected McCoy to hit him, He peered up at McCoy for a long moment and his throat worked as he gulped, “How’s Kirk, sir?”

“He’ll recover.” It was a pat answer, but a true one. Grady didn’t need to know the details.

Grady nodded and lowered his gaze. “Good. Great.” He seemed relieved, but then rushed to confess, “I didn’t mean to hurt him.” Red-cheeked, he mumbled, “He was right; I should have had my safety on. I forgot… and I’m sorry.” His head raised and he looked at McCoy beseechingly. “Tell him I’m sorry. Okay?”

Christ. He was too tired for this and he didn’t have the time or the inclination to hand-hold the cadet. On one level, he felt sorry for the young man. He was only a few years older than Jim, but obviously light-years younger in maturity and confidence. Failing out of the course was one thing; you could always try again the next time it was offered. But Grady was going to be dealing with more serious consequences than failing a course. He would be facing an inquiry into his actions. Seriously injuring a fellow cadet was a major offense, one that couldn’t be brushed aside. There would be demerits and a possible suspension in his future.

“I’ll tell him. Take care of yourself, Cadet,” McCoy said as kindly as he could, and nodded to the nurse. She gave him a grateful smile in return, then guided the hoverchair down the hallway.

He watched them disappear around the near corner. He wondered if Jim was going to be as forgiving. From what he knew, Grady had cost Jim his course record, and several weeks of his leave, which would now be spent in restricted activities and physical therapy. With a shake of his head, he returned to the recovery room.

He was barely two steps inside the door when the alarm sounded.

“Code Blue. Bed Four. Code Blue. Bed Four”

It took McCoy only a few seconds to absorb the meaning of the frenetic activity surrounding Jim’s bed, and only seconds more to sprint across the room.

“Report!” he barked.

Ryan gave him a frantic look as he replaced intravenous lines, dropping the old ones on the floor. “The unit of blood finished and I started the new meds that you ordered. They’d been infusing for only a minute or two, tops.” He twisted the cap off the end of the new line and inserted it into the central line catheter. “Then his pressure crashed, and he stopped breathing.”

“Code Blue. Bed Four. Code Blue. Bed Four”

“Pulse 32 and arrhythmic. O2 sat is 72 and falling,” Helen yelled from her position at the monitor. “Scan shows significant airway constriction. And it’s increasing.”

“Code Blue. Bed Four. Code Blue. Bed Four”

“Kill that damn alarm!” McCoy barked. “Start another IV line with normal saline _.”_

At the head of the stretcher, Dr. Tam rhythmically worked the ambu bag fitted tightly over Jim’s mouth and nose. “It’s getting harder to ventilate him, Dr. McCoy. The epi’s not working quickly enough.”

“Get a scope and an endo tube,” McCoy snapped. They were going to have to intubate Jim. And fast.

Another nurse scrambled to the emergency cart, yanked the top drawer open, removed both items and thrust them into Tam’s hands. The young doctor had abandoned the ambu bag in preparation for intubation, and McCoy could now clearly see Jim’s slack face and blue-tinged lips.

 _Fuck. What the hell had happened?_ “Ryan, were both the antibiotic and the morphine running?” 

“Yes.”

 _Goddamn it!_ He felt the bottom of his stomach drop. “He’s having an allergic reaction to one, or both, of the meds,” he said, knowing he was stating the obvious.

“I can’t get in,” Tam’s voice was high and thin. “I’m having trouble visualizing his cords.” He gestured helplessly with the laryngoscope in his hand.

Damnit, they were losing him.

“Move!” McCoy elbowed Tam aside and snatched up the scope and tube in one swift move. _Breathe, Jim. Breathe_. He slipped the scope into Jim’s mouth with practiced ease, muscle memory taking over.

The histamines being released into Jim’s body tissues had caused his tongue and mouth to swell alarmingly, forcing McCoy to constantly reposition the scope as he fought to obtain a view of Jim’s vocal cords past the edematous tissues. If they couldn’t get this in—

There! With a deft push, he shot the endo tube into the narrow opening.

“I’m in,” he announced. “Oxygen at 100%, now!”

Ryan hurried to connect the endotracheal tube to the ventilator’s oxygen line, then quickly secured the tube to Jim’s face, while McCoy moved to the foot of the bed. He reviewed the overhead monitor. “How much epi has he had?”

“2 mg IVP total,” Ryan replied.

“Push another 1mg every minute for the next five minutes. Helen, you call out the response. We’ve got to get his blood pressure and pulse up before he damages his organs.”

He didn’t want to look at Jim. This was a patient in crisis and he was a doctor. He worked the code like he’d done a hundred times before, trying to keep his emotions in check, his focus on keeping Jim alive.

Ryan hustled to obey. “1 mg epinephrine, IVP,” he announced, injecting the medication.

Helen stared at the monitor. “Pulse 40, and still irregular.”

Another alarm began to blare. “Respirations are tachypneic at 36 and shallow. O2 is 70.”

_Goddamn it! Too low._

“Another 1 mg epi on board,” Ryan sang out.

 _C’mon Jim._ “Prepare 5 mg of Duparadine and have it on standby.”

“Yes, doctor.”

From his reclaimed place at the head of Jim’s stretcher, Tam announced, “Ventilator volume is 953 mL. 14 cycles per minute. O2 at 100%.”

“Pulse 49. Sats have risen to 86.”

_Not enough._

“Another 1 mg epi administered,” Ryan said. “That’s three.”

He kept his eyes on the monitor even as Helen continued to proclaim the numbers.

“Pulse 66 and steadier. O2 sats are 94,” Helen called out, just as the respiratory alarm stopped flashing.

McCoy could hear the relief in her voice, and the other members of the team began to look less tense, as well.

A moment later, Tam punched the code button to silence both the visual and the audio alarms.

He could feel the adrenaline roaring through him like a wild river. Everything had moved at lightspeed and now they needed to take a breath and assess.

_First, do no harm._

He kept his eyes focused on the monitor. “Ryan, hold that next dose of epi. Let’s see if he continues to respond.”

“BP 92/52, pulse 76. O2 is still at 94%.”

He could live with those numbers. More importantly, _Jim_ could live with those numbers.

McCoy looked at his chronometer. “Code status terminated at 2033. Helen, call SICU and get a bed for him. Tell the charge nurse that I’ll accompany the transfer to write new orders and that I want to move him ASAP.”

“Will do, Dr. McCoy.”

“Ryan, keep a close eye on him. Let me know immediately if any of his vitals change for the worse.”

“Yes, sir.”

With the crisis over, he dropped his gaze from the monitor to Jim. A sickening tightness clenched his stomach. Jim was bone-white and unmoving. The intubation tube projected from between his slack lips, and was securely taped to his colorless cheeks. Faint shadows rode beneath his closed eyes and Jim’s pallor was so extreme that his lashes looked inky-dark against his pale skin.

McCoy reached down and gently smoothed Jim’s hair. He let his palm rest for a long moment on Jim’s forehead and simply breathed, silently offering up his jumbled feelings.

An apology.

A promise.

Lifting his hand, McCoy nodded soberly to Tam, who still looked shaken by the recent events. Then, on knees that were less than steady, he headed to the circulation desk to begin researching antagonistic drug interactions and Jim’s allergy history while he waited for the intensive care unit bed to become available. He tried to ignore the reproachful voice in his head.

_Jesus Christ, he had nearly killed his best friend._


	3. Chapter 3

McCoy paced the small confines of the Intensive Care room where Jim lay. The rhythmic sound of the life support machines played beneath the soft chimes and beeps of the overhead monitor. All of it was out of harmony, creating a poorly conducted orchestra that set McCoy’s nerves on edge. Occasionally, he’d stop pacing long enough to watch Jim, to remind himself the man in the bed was more than just a patient. Jim had become a close friend. The only one he had at the Academy. He didn’t exactly make friends easily, and to tell the truth, he hadn’t been looking for any when he enlisted in Starfleet. Jim had just showed up in his life – alone and cutting the ties to his old life – just like he had. Maybe it was that simple. Maybe they were more alike than he thought, even if they had different goals. At the end of the day, they both just wanted something new.

But it was more than that, too. He didn’t know much about Jim’s personal life, aside from what was public, and Jim didn’t speak much about his time in Iowa except to say it wasn’t worth talking about. McCoy didn’t know what to do with that response, but he recognized pain when he saw it, because Jim got the same look in his eyes talking about Iowa and family that McCoy got talking about Georgia. So, the young arrogant kid who wanted to graduate the Academy in three years and get his own ship in five, had become friends with the seasoned trauma surgeon who hated space and had joined Starfleet anyway. And wasn’t that just a kick in the ass.

Friends. Jesus. He ran a ran through his hair. Doctors didn’t treat friends or family. It was a cardinal rule of the profession and for good reason. A doctor – especially a surgeon – needed emotional distance and objectivity to do the job right. He’d done a decent job of establishing his boundaries with Jim. But in the past forty-eight hours, he’d stepped over the line dividing patient and friend a dozen times. Boyce, the head of medicine at the facility, had told him to get used to it.

_“If you serve on a ship, you’re going to be friend and physician to everyone on board. Learn to compartmentalize,” Boyce said._

Great fucking advice.

He walked up to the side of the bed. The intubation tube was still in place and made Jim look artificially alive. Pale and sallow, his motionless figure seemed to fade into the bleached linens, a shadow of its former vibrant self. Swallowing past the tightness in his throat, McCoy raised his gaze to the monitor for the umpteenth time, as if the display would change to something more hopeful if he looked often enough.

Jim’s blood pressure was still low, stubbornly slow in returning to a more normal readout despite the blood and fluids he had received. McCoy sighed. It was a likely side-effect of the allergic reaction syndrome. But knowing that didn’t make him any happier with the numbers. And Jim wasn’t showing any signs of consciousness. They couldn’t get him off the machines without Jim’s cooperation.

_Come on, Jim. Help us out._

Lab tests had confirmed that Jim was allergic to both drugs he had given him, which was why he had experienced such a severe reaction. The only comforting thought McCoy had was that he hadn’t missed any known allergies recorded in Jim’s chart. Despite his fatigue, he hadn’t been medically negligent. Jim’s limited medical history hadn’t listed either the antibiotic, Cephalazen IV, or Morphine as known allergic agents. Cephalazen IV was the most common broad-spectrum antibiotic in the Federation. That Jim was allergic to it was extremely concerning and didn’t bode well if Jim developed an infection. They’d had to try another antibiotic from a different family, but it wasn’t as powerful, and McCoy was concerned about its effectiveness given the results of Jim’s culture and sensitivity results.

But right now, that was a secondary concern. Jim had been on full life support for two days, his lungs still not functioning normally. The tissue in his bronchial airway was still swollen, though it had shown some improvement with the Cortizene he’d prescribed. Without the ventilator’s assistance, Jim would spiral down into full respiratory arrest. Even now, the monitors indicated that Jim’s labored inspiratory effort was weak, causing the ventilator to trigger regular breaths for him. And it was risky to keep him intubated for a long period of time because it could create dependency on the machine, making it harder to wean Jim off it. The endotracheal tube also opened Jim up to infection and pneumonia, thanks to his already compromised immune system.

McCoy glanced down at Jim’s bandaged leg, still visibly swollen despite being constantly elevated and iced, but it _was_ healing. That was about the only thing that was going well— unless you also counted the fact that Jim was still alive. Pushing the blanket aside, McCoy pressed his fingers to Jim’s ankle and checked the pulse. Satisfied, he covered the injured leg again and walked closer to the head of the bed.

“Why do you have to make everything so difficult, kid?”

He brushed back the strands of light hair that tended to stand straight up in all directions, despite the regulation cut. The swelling around Jim’s eyes had decreased, but they still had a sunken, bruised look. The red hives that had covered his chest and neck had resolved, which indicated Jim was making progress, however slowly, in his recovery.

But, Christ, it had been close. Still was. In all his years of training and practice, he’d never seen such a severe allergic reaction. They had been damn lucky to get the endo tube in place before Jim airway closed completely. They’d managed to support Jim’s breathing and avoid a full cardiac arrest or brain damage due to lack of oxygen. Jim’s youth was an advantage, of course. He was young and strong and in excellent shape. There was no reason to expect he wouldn’t make a full recovery.

With a sigh, McCoy walked back to the foot of the bed, as if his vigilance would make things better. He’d been standing in place for several long minutes when he heard the soft hiss of the automatic doors opening and the sound of brisk footsteps. Footsteps that abruptly stopped a few paces inside the door.

After a prolonged moment of silence, he turned his head, curious. Medical personnel didn’t hesitate that way, which meant it was someone else, although visitors had been prohibited. So, McCoy was both surprised and annoyed to see the familiar figure of Captain Pike standing just inside the room. The older man was dressed in a crisp, dark-grey uniform, his captain’s braids decorating his shoulders. His seemed transfixed by the sight of Jim, judging by his expression, a combination of utter astonishment and dawning horror.

“Can I help you, Captain?”

Pike didn’t move or acknowledge him. Standing military straight, he stared at Jim, while the soft swoosh of the ventilator played rhythmically in the background. McCoy knew that Pike had recruited Jim, just as he, McCoy, had been recruited by the persuasive captain. But as far as he knew, that was the sum total of the relationship between the two men. The only thing Jim had ever said about Pike was that the man had known his father. Any further attempt to find out more, had only gotten McCoy a dismissive shrug. So, what would a career Starfleet commanding officer be doing in the ICU of a first-year cadet? In fact, what was he doing in the ICU at all?

Scowling, McCoy turned to face Pike. “This area is restricted.”

Pike’s gaze didn’t waver. Finally, he took a few long strides, walking quietly to Jim’s side and staring down at him. For a moment, McCoy thought the Captain was going to touch Jim, but he just stood there, back ramrod straight, looking helpless and confused.

“How is he?” he asked in a low voice, as if he were afraid of the answer.

“Critical.” How the fuck could Jim be anything but critical? What was Pike thinking? The kid was on a ventilator, for Christ’s sake.

Pike turned his head in McCoy’s direction. “This is an allergic reaction?” It sounded more like an accusation.

McCoy pressed his lips into a grim line and scowled back at Pike. He still wasn’t comfortable with military protocol. In private practice, a patient’s records were sacred. Privacy was paramount. In the civilian world, he’d have been forbidden to speak to Pike on Jim’s condition without Jim’s express permission. But in Starfleet, command had access to everything – history, treatments, prognoses – which was how, he suspected, Pike was here. He must have been alerted. Nothing was private or secret at the Academy for long. “A _severe_ allergic reaction. To the medication I prescribed.”

Pike stared hard at him for a long moment, then glanced back at Jim and raked the young man with a steely-eyed gaze from head to toe. McCoy wasn’t certain what Pike was looking for, but he’d already outstayed his welcome. Jim didn’t need people watching him as he lay vulnerable and unconscious with a bevy of tubes sticking out of him.

“You shouldn’t be here,” McCoy said sharply, coming to stand closer.

“I wanted to see him.”

“He doesn’t need people gawking at him.”

Pike’s head snapped up at that. His light eyes darkened for a moment and McCoy caught the full view of the hard-ass commanding officer the new cadets talked about. Pike didn’t like being chastised. Then, something shifted in his expression and the measured diplomat surfaced. “I’m not here to interfere, Doctor. I was just concerned. I knew he’d gotten hurt on the course. I’d been told it was minor.”

“What idiot told you that?”

Pike ignored the question. “I didn’t know his status until this morning when I read the report.”

McCoy’s scowl deepened. “And now you know.”

Pike’s eyes narrowed before he looked back at Jim.

Sidra, the ICU nurse, entered the room and handed McCoy Jim’s chart. “Recent labs.”

McCoy nodded, but didn’t immediately review the results. He was still studying Pike, who was watching Jim.

Sidra nodded to Pike as she checked the IVs and ventilator. “Captain.”

Pike reluctantly looked away from Jim, nodded to Sidra, and turned toward the door. “I want a report every four hours, Doctor.”

Pike was gone before McCoy could reply.

“That was weird,” Sidra said. “We don’t get command in here very often. Does Kirk know him?”

He nodded absently and reviewed the information.

“Goddamn it,” he said under his breath. They couldn’t catch a fucking break.

Sidra looked at him sympathetically. “Not what you were hoping?”

“His white cell count is up. It’s 12,000.” _Shit._ He affixed his signature to the report to verify he’d reviewed the results and laid the PADD aside. He drew a heavy breath. “We need to rule out an infection.”

“His leg, do you think?” Sidra asked.

“Leg or lungs.” _Jesus, he hoped it wasn’t Jim’s lungs._ “Draw a chem panel and a CBC with diff. I want to check for a left shift. And get full scans of his leg and chest, too. If this is a new infection, I want to get on top of it now.” He already had Jim on antibiotics, though it wasn’t his drug of choice. So, with an antibiotic agent already being administered, it was worrying that Jim might be developing an infection.

“Do you want to continue the Cortizene drip?”

“Yes,” McCoy said tersely, although he knew why she was asking. Cortizene was a powerful anti-inflammatory, and it was an excellent therapy for lung inflammation. Pulmonologists considered it the miracle drug of choice for asthmatics. But it also suppressed the immune system, the system the body used to fight infection. If Jim was harboring a growing infection…

“I’ll wait on all the test results before I make any changes to his drug regimen,” he explained. “The elevated WBC could be drug induced. We’ll hope that’s the case.”

“Of course, doctor.”

The Cortizene therapy was vital to Jim’s recovery plan. Without it, the extubation process would take much longer. If that occurred, especially given Jim’s temperament, the process would become an excruciatingly delicate and exhausting undertaking.

All he could do now is wait. With a heavy sigh, McCoy turned away from the monitors. “Let me know the minute he shows signs of waking.”

“Yes, doctor.”

He needed a cup of coffee. And another consult with Truman Merriweather, the Pulmonology Chief of Staff.

Two cups of coffee and four and a half hours later, McCoy was making his way from the east wing of the medical center to the Intensive Care ward when his comm beeped. He’d set the comm to Notify, a habit he’d gotten into when on duty in the hospital. There were times, as a doctor, that he couldn’t immediately answer a comm or when he didn’t want to be interrupted while with a patient. The comm beeped once when in Notify status, as it logged the request for a response, which gave him flexible communication options.

He flipped the comm open without breaking a stride and read the displayed message: Boyce wanted to see him. He scowled. What the hell? He was technically on his four-week break. All Academy classes had been completed and grades had been posted. The academic year was over and that included any medical responsibilities he’d had as part of his first-year curriculum. He was only at the hospital and ‘on duty’ because of Jim, who was his only patient. As Surgical Chief, Boyce had to have been aware of how critical Jim was as soon as Jim was admitted to the surgical intensive care unit. Why was he demanding a meeting now?

McCoy’s steps slowed, then stopped. He was torn. Right now, all he wanted was to get back to Jim’s bedside. Although he’d been monitoring Jim’s chart and knew that nothing had changed since he’d left the intensive care unit, he hated being a ten-minute walk away if something did happen. The consult with Merriweather had been lengthy. He’d challenged Merriweather at every negative prognosis to dig deeper for a solution. The man was good, but McCoy wasn’t going to accept standard treatment approaches for Jim, who didn’t present with the typical symptoms.

_“Intubation is past our recommended length, but it’s the only option for now. His bronchial airway is still significantly inflamed.”_

_As if McCoy didn’t already know that._

_“He isn’t conscious enough at the present time to pull an adequate title volume on his own, Len,” Merriweather said, reviewing Jim’s chart for the second time. “Right now, our hands are tied.”_

It hadn’t been a particularly inspiring meeting. Against all logic, he’d hoped for more.

He looked again at the message and with a soft growl of frustration, turned right at the next corridor intersection, to make his way to Boyce’s administrative office. Halfway there, his comm beeped again. He immediately flipped the comm open and saw another message, this one flagged as ‘urgent’. Captain Pike was demanding to speak to him immediately. He scowled at the terse line of text but pressed ‘accept’ and waited impatiently to be connected with the captain. He’d gone his entire first year at the Academy without once speaking to Pike and now this would be his second conversation in a handful of hours with the man.

It wasn’t Pike who answered, but his assistant, who coolly asked him to hold, which pissed off McCoy even more. His first priority was Jim’s care. He was busy, for Christ’s sake. He didn’t have time for this crap. His footsteps drummed against the floor as he briskly closed the distance to Boyce’s office, hoping to conclude whatever business he needed to and get back to Jim.

“Do you have a problem understanding orders, Dr. McCoy?” Pike’s voice was clear and terse as it came through the small comm, taking McCoy by surprise.

McCoy saw red as he jerked to an astonished halt in the middle of the corridor. He took a firm hold on his temper. “I understood your orders, Captain.”

“I see. Then it’s _following_ orders that you find difficult. I told you I wanted a report every four hours.”

Christ. McCoy stopped. The corridor was lightly populated with medical personnel and administrative staff. He didn’t want to have this conversation here. “I was consulting w—”

“I don’t care what you were doing. If you can’t follow simple orders, I’ll remove you from Kirk’s care and find someone who can.”

Who the fuck did this man think he was? Medical personnel took their orders from Medical Command, who had no direct line to military command. And for good reason. His mouth tightened. He was about to speak, when Pike did.

“What’s Kirk’s status?”

It took him a moment to respond.

“Still critical. Sir.” With an effort, he shifted his tone, as if he were relaying results to a fellow physician. “He’s still on full life-support. We’re waiting on labs for his blood results. His white cell count is high, requiring that we rule out an infection.”

Silence.

“Is that likely?”

McCoy rolled his eyes. “His wound was open in the field for more than twenty minutes, Captain, so, yes, an infection would not be surprising. But it could also be a reaction to the medication, complicated by the anaphylactic shock syndrome.”

Another pause.

“Kirk was allergic to the antibiotics, right?”

“To the first one yes.” He understood where Pike was going. “But there are others we can use. He’s on a different broad-spectrum antibiotic now and tolerating it well.”

He heard Pike release a deep breath. “I want that report, Doctor.”

With that the communication abruptly ended. McCoy stifled a curse and shoved the comm in his pocket.

Three minutes later he was in Boyce’s office where he spent the next thirty minutes getting a lecture on Starfleet protocol. Pike, apparently, had quite a few things to say to Boyce, as well. He endured the lecture for one reason only. It turned out, Pike could remove him as Jim’s physician.

_“Don’t make an enemy of him, Leonard,” Boyce said. “Chris Pike’s a good man. His amity and backing are valuable assets. If he considers Kirk his mentee…” Boyce shrugged. “A personal interest isn’t all bad.”_

_“I thought I was supposed to compartmentalize.”_

_Boyce regarded him kindly. The senior medical officer had practically been raised in Starfleet. He had gone to medical school at the Academy, done his internship and residency at Starfleet General and had served on a starship. Starfleet protocol was written into his DNA. “This isn’t civilian practice. Commanding officers have influence.”_

_McCoy pursed his lips. “Doesn’t the patient’s wishes mean anything?”_

_“Not when the patient is unconscious.” Boyce leaned forward across his desk. “Look, Chris cares about Kirk. He’s worried.”_

_Chris. Not captain. Interesting._

His conversation with Boyce was cut short by another comm alert.

Jim was waking up.

Making his apologies, McCoy had hurried for the door.

By the time he got back to Jim’s room, three medical personnel were crowded around the bed. He recognized Sidra and Troy, the ICU floor nurses, but not the third individual, a woman with high cheekbones and ink-black hair cropped closely to her skull. As he neared the bed, he could see Jim moving weakly. Sidra stepped aside to give him more room.

“He’s fighting the ventilator a little,” Sidra said.

He nodded, his eyes on Jim. The blond brows twitched, once, twice, then his brows pleated, deepening the lines around his eyes. Moments later, his forehead creased, and his head moved restively against the pillow. Tension tightened the pale features.

McCoy glanced quickly at the monitor. Jim’s heartrate was increasing. As he became more fully conscious, his stress would increase. His awareness of the ventilator – a tube down his throat, forced inhalations – would only add to the stress he was experiencing. And yet, Jim needed to be conscious for them to get him off the ventilator. It was a nasty Catch-22 situation.

“This is Lara,” Sidra said, introducing the black-haired woman. “She’s the respiratory therapist assigned to Cadet Kirk.”

He barely acknowledged her, his entire focus on Jim. Jim’s hand moved, and McCoy quickly captured it. Patients who were intubated and regaining consciousness often tried to pull the tube out, an instinctive response as they tried to clear – what they thought was – the obstruction. The last thing he needed was Jim extubating himself and having to reinsert the endotracheal tube again.

Lara moved closer to the bed on the opposite side.

Jim’s lashes fluttered, and his fingers twitched weakly in McCoy’s grip. Finally, by slow degrees, the bruised lids lifted, and Jim’s eyes opened for the first time since entering the operating room.

McCoy swallowed hard and gave Jim’s hand a reassuring squeeze. “Welcome back, kid.”

The brilliant blue gaze darted anxiously around the room. McCoy heard the heartrate monitor begin to beep faster.

“Jim, you’re in the hospital,” he said succinctly, trying to penetrate the fog of medication and exhaustion. “You have a tube down your throat that’s helping you to breathe. It’s preventing you from talking.”

Jim’s fingers convulsed on McCoy’s hand as his eyes widened.

“You’re okay, Jim. You had an allergic reaction to some of the medication we gave you,” he said deliberately, watching Jim’s reaction, looking for a sign that Jim was comprehending. “Your airway is still swollen, so try and let the machine breathe for you.”

The ventilator pushed two more breaths into Jim. He moved restlessly, his frown deepening. He rolled his head against the pillow, frowning as the tape securing the endo tube pulled at his skin. Looking away from McCoy, he flexed his right leg beneath the blankets, as if he were going to try and leverage himself off the bed.

The monitor pinged in warning.

“Heartrate is 120 and rising, Dr. McCoy.”

Jim closed his eyes tightly and suddenly arched up on the bed. Quickly, McCoy released Jim’s hand and used both of his hands to cup Jim’s face, feeling the sullen heat of fever against his palms. “Listen to me, Jim, you need to stay calm. If you become agitated, you’re gonna trigger a coughing spasm.”

Jim’s eyes flew open and locked onto McCoy’s.

Another warning sounded.

“He’s bucking the respirator,” Sidra warned. “Ventilatory pressure is increasing to try and compensate for his resistance. Should I prepare a paralytic?”

“No. Standby with 2 mg of Versed.” He didn’t have to say “in case this goes south” because everyone in the room knew that a conscious, panicking patient usually resulted in a bad outcome.

From the corner of his eye, McCoy could see Sidra hastily open the med drawer and begin preparing the syringe. Within seconds, she announced, “Versed ready, Dr. McCoy.”

He gave her a curt nod but didn’t take his focus away from Jim as he spoke. “I know it’s difficult. I know it feels like you can’t breathe, but that’s just the tube, Jim. Listen to my voice. I need you to relax and _stay still_. Let the ventilator do the work.”

Jim’s left hand encircled McCoy’s wrist with a weak grip.

“I know, kid. I know it’s uncomfortable, but you have to relax.” He kept his voice smooth and calm. “You’re gonna be okay.” He stroked his thumbs along the crest of Jim’s cheekbones. “I’ve got you, Jim. I’ve got you. You’re safe.”

“His heartrate is coming down,” Sidra said. “He’s not fighting the respirator as much.”

McCoy kept both hands on Jim’s face, as much to steady the young man as to keep him grounded. The tension around Jim’s eyes lessened slightly as the ventilator continued to push oxygen into his lungs. Jim’s right hand darted toward his head and Lara quickly caught it in a light grip. That immediately set Jim off. He violently tugged out of her grip.

“Release his hand,” McCoy said quickly, without taking his eyes off Jim. “Don’t restrain him.” He needed Jim to stay relaxed, remain still and focused. Restraining him would only increase his stress. If Jim stayed calm and didn’t attempt to remove the tubing, McCoy wanted to keep him unrestrained. He was calculating the sound of the beats, listening for the slowing of Jim’s heart rate. “That’s right. Just let the machine do all the work.”

McCoy continued to gently smooth his thumbs over Jim’s hot skin. “Relax. Don’t worry about the tube. We’re gonna get that out soon.”

“Heartrate is coming down. 110. No, 102.”

Jim stared steadily at him, the pale lids heavy with fatigue. McCoy saw the quicksilver intelligence in the startling blue eyes. And the fear.

“Relax, Jim. That’s right.” Whether it was exhaustion or McCoy’s soothing, Jim slowly settled, keeping his left hand on McCoy’s wrist. McCoy felt Jim’s fevered fingers flex.

“You’re doing good. Everything is all right.”

When McCoy was certain Jim was more relaxed and comprehending, he looked away from the blue gaze to quickly review the monitor readings. Satisfied, he caught the respiratory therapist’s eye with a raised eyebrow.

She nodded, tuning into his unspoken instructions.

“Jim,” McCoy said. “We’re going to see if you can breathe on your own. We’re going to keep the tube in but disconnect the ventilator. Do you understand?”

Jim frown slightly but gave a small nod.

“Good. I don’t want you to touch the tubing. It’s hollow, so you can breathe with it in place.” He slowly removed his hands from Jim’s face. “We’ll tell you before we disconnect the machine.” McCoy lifted Jim’s hand from his wrist and, gripping it gently, moved it slowly to Jim’s side. All the while, he kept an intense focus on the young man, noting that his pallor had increased.

“We’re going to disconnect you now, Jim. Get ready to breathe, okay?”

Lara waited for his signal to begin. At his nod, she disconnected the ventilator from the endo tube that protruded from Jim’s mouth and reconnected the oxygen line, via a sensor valve, directly to the tube. The sensitive equipment would measure how fast Jim was breathing on his own, how much air his lungs could take in an individual breath and indicate how strongly he was inspiring without the draw of the ventilator.

Masking his own anxiety, McCoy waited with outward calm as Jim’s lungs deflated. He found himself holding his breath, counting the seconds, as he waited for Jim to take his first breath on his own. The machine, now disconnected, couldn’t be triggered by the need for oxygenated air. It was all up to Jim now and McCoy desperately hoped the young man would be able to get his lungs to work effectively. Jim’s frown deepened, then he drew a single, hitching breath.

Lara was studying her PADD, watching the results feed into the chart. “Good, Jim,” she said. “That’s a good breath, a good effort.”

Jim eyes grew bright with distress. Tiny beads of sweat formed on his forehead. With a concentrated effort, he took another breath, deeper this time. McCoy could see the pain and struggle to pull air into his inflamed lungs. Three… five… six effortful breaths. Then his hand clutched desperately at McCoy’s, who returned the pressure in a reassuring grip. The next breath was shallower and slower to come.

The monitor chimed a warning.

Lara looked up from the PADD to Jim and waited.

“You’re doing good, Jim,” McCoy said, squeezing Jim’s hand in encouragement.

Another shallow, short breath and Jim began to pant. Sweat rolled off his face.

The chimed pinged again.

“Respirations are 36 and increasing,” Sidra called out.

Lara moved to quickly reconnect the ventilator. Oxygen-rich air flooded Jim’s lungs as they inflated. Jim closed his eyes, looking exhausted. A little color returned to his face. McCoy gently wiped the perspiration from Jim’s face as the lines of distress and tension faded.

“We’ll try again in an hour,” Lara said to McCoy. “His numbers look good.”

McCoy nodded, not looking at her. He knew Jim wasn’t asleep from the tight grip he had on McCoy’s hand, despite needing to rest before they tried again. “You did good, Jim. We’ll try again later, after you’ve rested.” He looked over at Sidra. “Push 2mg of diazepam, slowly.”

Weaning a patient from a respirator was a tedious process, requiring strength and stamina from the patient, and encouragement and patience from the clinicians. Jim was still obviously weak, and his lungs were being uncooperative, making the entire process difficult.

Jim’s eyes fluttered, as if he were fighting drifting off. His hand still clutched McCoy’s.

“I’m not leaving, Jim. I’ll be right here. You need to rest now. I’m going to give you a little medication to help you relax until we try again, but I’ll be right here.” He watched as Sidra deftly injected the drug into Jim’s intravenous line.

Jim’s fingers twitched, tightening and releasing, his grip getting weaker and weaker.

“Go to sleep, kid. Everything is all right.” He continued to speak softly, and slowly, slowly Jim’s fingers went limp as sleep claimed him.

McCoy sighed and released Jim’s hand, feeling his own fatigue. With a conscious effort, he forced his tense muscles to relax, and took a few deep breaths before he glanced at his chronometer. He owed Pike his damn report. If he was lucky, he’d have time to grab some rest, too, even if it was only leaning back in a chair at Jim’s bedside with his eyes closed.

They had a long road ahead of them. It would likely take another day to get Jim off the ventilator and McCoy wanted to be with him at every attempt. He rolled his neck, wincing as the vertebrae in his neck cracked. Just as he turned away from the bed, Troy appeared in front of him and handed him Jim’s chart.

“Lab results.”

He reviewed the report and breathed his first sigh of relief. No infection. The fever was likely due to the cocktail of medications being pumped into Jim. Still, until it resolved, it was a concern and they’d need to closely monitor him to prevent dehydration. A fever would sap Jim’s energy, as well. They’d dodged a major complication, though. An infection would have been a major setback at this point. Especially given Jim’s allergies.

“Thanks, Troy. Give him a 650 mg of acetaminophen suppository right away. Try not to wake him.”

“Right away, Dr. McCoy.”

Now all they needed to do was get Jim breathing on his own.


	4. Chapter 4

Chapter Four

Gripping a fresh cup of coffee, McCoy reviewed Jim’s latest test results with tired, bloodshot eyes.

The last forty-two hours had been grueling on everyone, but the effort had been worth it. Jim was now extubated and breathing on his own. It had been a hard-won victory, a testament to Jim’s stubbornness and determination to shed the endotracheal tube. But it had been difficult to witness.

McCoy had been with Jim at every attempt, reassuring and encouraging him as drew one wheezing breath after another. The forced confinement and subsequent exhaustion after each attempt to breathe on his own had taken a toll on the young man. McCoy had to gently remind Jim he was making good progress, but the frustration was clear in his friend’s eyes and in the tight grip he’d kept on McCoy’s hand.

Yesterday, at 2000 hours, Jim had finally been deemed strong enough to breathe on his own and Lara had removed the ventilator connection and McCoy had deftly removed the breathing tube. The extubation process had been mercifully quick but still difficult for Jim. When it was finally out, he had coughed weakly for nearly a full minute. When the coughing spasm finally subsided, he had fallen into an exhausted sleep, unaware of the oxygen mask being placed securely around his nose and mouth. McCoy had stood by his bedside for another hour, listening to the wheezing breaths and trying to reassure himself that Jim’s lungs weren’t going to fail. Then, finally, exhausted himself, he’d left to get some much-needed sleep in the nearby on-call room.

He looked at his chronometer. That had been ten hours ago, but it could have been ten minutes given how tired he still felt.

Taking another sip of coffee, he reread the test results before confirming. The elevated white cell count had dipped a bit and hovered around 10,000 – the high side of normal. The leg was looking good, too. The swelling was nearly gone, and Jim no longer needed the constant application of ice packs.

Now, if his lungs would just show the same kind of cooperation…. Sighing, McCoy tucked the PADD in its holder and, casting a last look at the monitors, left to begin preparing his next report for Pike.

A few hours later, McCoy stood near Jim’s bed, arms crossed, eyes fixed on the young man, willing him to wake up. Even with the oxygen mask on, the sound of Jim’s wheezing was clearly audible over the other noises in the room. The harsh rasping breaths made McCoy wince. They’d inclined the head of the bed to aid his respiratory efforts. A soft light glowed directly over the bed, providing the necessary illumination required by the medical personnel to safely do their work. But the lights in the remaining area of the room had been lowered to encourage Jim to rest. Jim look paler in the muted light, his face visibly thinner than it had been a week ago. McCoy glanced up at the monitor. It had long since become a habit, and the readouts assured him that Jim was cycling up from the light sedation administered at night to ensure that he slept.

It wasn’t only Jim’s lungs that continued to be a problem. The high fever persisted, dipping slightly with each new dose of antipyretics, and roaring back when the medication waned. And Jim’s O2 sat was lower than McCoy liked, although the reading wasn’t surprising given the state of Jim’s lungs.

It took another twenty minutes before Jim began to move. His wheezing worsened as he shifted restlessly, and he struggled to take one slow and laborious breath after another.

McCoy captured one of Jim’s restive, hot hands, and grasped it firmly in his own. “Jim, you’re okay. Try to stay still and focus on your breathing.” Reminders to orient the young man had become a habit, as well.

Jim mumbled something unintelligible, then had to stop talking as he struggled for air. His face was pinched with tension.

“Don’t try to talk. We removed the ventilator last night.” McCoy positioned himself so that Jim could see him, leaning in close to the fever-flushed face. “But your lungs are still inflamed, so try not to stress them by talking.”

Jim stared at him for a long moment, then released his grip on McCoy’s hand and moved his hand to the oxygen mask.

McCoy caught his hand and stopped him from touching the mask. “That’s an oxygen mask. You’re going to need it to help you to breathe for a while. You have to keep it on.”

Jim’s frown deepened, and he rolled his head looking around the room. He mumbled something and his hand jerked weakly in McCoy’s as if to tug it free.

McCoy continued to grip Jim’s hand and, using his other, laid a gentle and grounding hand on Jim’s head. “Everything is okay. Your lungs are just a little irritable right now. It’s difficult to breathe, I know, but the inflammation is improving.”

The soft ping of the monitor sounded. McCoy glanced upward to confirm what he suspected. Jim’s O2 sats were dropping. “Take some deep breaths, Jim. I know it’s difficult, but you have to keep your lungs inflated. We don’t want to put you back on the ventilator.”

After a few more wheezing breaths, Jim tugged at his captured hand and McCoy reluctantly released his grip, all the while studying Jim closely. Jim looked away, turning his head slightly to look at his elevated leg. His fingers clumsily exploring the thick bandage that encompassed his thigh.

McCoy patted his hand. “Your leg will be fine. I repaired the damage and once it finishes healing, it will be as right as rain.” He continued to study Jim, whose frown seemed frozen in place. “We’ve been holding off on the tissue regenerator until your lungs improved in order not to tax your system. Does it hurt?”

Another wheezing breath. Jim nodded.

“Okay, Jim.” He’d reduced Jim’s painkillers last night, not wanting to compromise Jim’s respiratory system. Now he reached up to the IV control panel and punched in the command to increase the painkiller he’d prescribed. “That should help. In a day or two we’ll restart the regen therapy and any pain you’re experiencing will go away once it’s completely healed.”

The tension around Jim’s eyes visibly lessened as the medication hit his bloodstream.

“Better?”

Jim nodded. After a few more labored breaths, he spoke. “How long?”

“How long have you been here?”

Jim nodded.

“You came into the ER four days ago.”

McCoy could see Jim processing that. Confusion clouded the fevered eyes. His heartrate picked up.

“Year done?” Jim asked weakly.

“Yeah, Jim. The year’s over. Everyone’s on break.”

Jim closed his eyes and wheezed in another few breaths. McCoy took the opportunity to glance at the monitor. A few indicators were yellow, but nothing too alarming. Damn fever. He turned his attention back to Jim and saw the man had curled both hands into fists.

“Hey,” McCoy said gently, putting a hand on Jim’s shoulder. “Stop worrying. You had a good year, kid. You made it through the year ahead of schedule, just like you intended.” And at the top of his class in everything, despite the crushing load of coursework he’d carried.

Jim slowly opened his eyes, and from the look in them, he wasn’t buying McCoy’s assessment.

“Failed … fu-ing manu-”

McCoy took a deep breath. “You didn’t fail, Jim. You just didn’t pass. You’ll get it next year.”

Jim rolled his head away and closed his eyes, defeat etched into every line of his body. So much for his pep talk.

Sidra entered the room and deftly maneuvered around McCoy, checking IV lines and replacing a nearly empty bag of IV fluids with a fresh one. She examined the oxygen line, urged Jim to take a sip of water and repositioned the mask on Jim’s face after he finished the few sips he managed between breaths. Throughout her care, Jim remained quiet. When she left, he turned his gaze back to McCoy.

“You’re…not leaving, too?”

“Of course, I’m not leaving, you idiot.” McCoy clasped Jim’s near hand, “I’ve been taking care of you since the accident. I’m not going to stop now.”

He saw Jim smile briefly beneath the clear mask. But the smile quickly faded, as Jim put his other hand to his chest, splaying out his fingers and pressing.

“Chest hurt?” McCoy asked, all his senses on alert.

“S’kay.” Jim’s words were slurred.

The monitor chimed.

McCoy glanced up and saw that the O2 sat had dropped to 93 and Jim’s respirations had increased. He looked back at Jim. “I need you to take some deep breaths for me, Jim. Slow your breathing down. Slow and deep. I know it’s uncomfortable, but you have to try to breath as deeply as you can and push some air all the way to the bottom of your lungs.”

Jim frowned as he concentrated on following McCoy’s request, taking a few, labored, deep breaths. It was normal for a patient coming off a ventilator to have some challenges in controlling their respirations. Jim’s lungs were still healing and fatigued easily. But the last thing McCoy wanted to contend with was pneumonia. They were going to have to start respiratory therapy soon to keep Jim’s lungs clear.

The sats came up, but the effort had cost Jim what little energy he had. The kid looked limp.

McCoy comm beeped. He kept his grip on Jim and fished the comm out of pocket with his free hand. Using his thumb, he flipped the cover and read the message.

Pike. Of course.

Frowning, he shoved the comm back in his pocket.

“’Wha’s wrong?”

“Nothing for you to worry about.” He looked directly at Jim and gently squeezed his hand. “Get some sleep, kid. You need it.”

Jim’s eyes were already drifting close.

McCoy reluctantly let go of Jim’s hand and straightened, arching the kink out of his back. He had to deal with Pike.

* * *

Jim lay against the soft cushion of the biobed, forcing air into his wheezing lungs. Each breath was painful and taxing, as if a heavy anvil sat atop his sternum. He put a hand to his chest, trying to ease the deep ache that had settled beneath his ribs. It was only a slight distraction from the throbbing in his leg. To top it all off, his body felt as though it had been violently twisted and wrung dry. Every muscle ached, as if they had been stretched thin, and he didn’t even have the energy to lift his head off the pillow. His entire focus was consumed by the need to keep breathing. But when his concentration faltered, his thoughts immediately turned to the failed maneuvers.

Sidra, the pretty auburn-haired nurse, entered his room with a smile. “Good morning, Jim. It’s good to see you awake.”

Morning? He had lost all track of time. His memory consisted of bits and pieces, from the time he’d entered the ER to now. Bones had told him he’d been here four days. Had that been yesterday? He only remembered the marathon of trying to breathe, waking for brief moments to pain and distorted images, and the renewed exhortation to breathe, breathe, breathe. As if he wasn’t trying to do that already.

Sidra buzzed around him, checking the IV port and lines that had been inserted into his left hand. He followed the IV lines up to the bank of solutions that hung above his head. A half dozen bags of various sizes, each bearing a pharmacy label on which he could just make out his name, loomed overhead. That wasn’t good. Fuck. He needed to get out here, so he could enjoy whatever remained of his leave.

“Can I get you something?” she asked once she finished fussing.

“What day… is it?” His voice sounded weak and thin. His throat was still sore from the tube they’d stuck down it, and the constant presence of the oxygen mask was making it dry.

“Thursday.” She moved away, out of his line of sight, and returned with a small cup of ice. “Try some of these. Hold them in your mouth until they melt. The oxygen tends to dry out your throat. Prolonged use can get uncomfortable.”

Having someone slice through your leg and shove a tube down your throat was uncomfortable. This was just annoying. Still, he cooperated as she removed the mask and fed him a spoonful of ice chips. The cool chips of ice melted quickly, and the liquid trickled down his throat. He opened his mouth for another, wheezing in another breath. Shit, it hurt to breathe. It was like breathing through a wet, clinging cloth, and without the mask’s assistance, his body felt the familiar pangs of oxygen-starvation squeeze his chest. The room tipped and blurred. He wanted more chips, but Sidra put the mask in place, sealing it over his nose and mouth. His ears started to ring— or was that the monitor alarm?

“That’s all for now,” she said apologetically.

He gulped greedily at the cool oxygen, gasping, until his vision cleared.

Sidra glanced up at the monitor. A faint scowl puckered her brows.

“S’ming … wrong?”

She looked down at him and smiled, then patted his arm and said, “Nothing for you to worry about, Cadet.”

And, on the heels of that hollow reassurance, she left, and he was alone. Alone with the sound of his wheezing. He looked around the room, seeing it for the first time. Though well-lit, there was no natural light or windows or clock, so if Sidra hadn’t mentioned it was morning, he would have had no idea what time of day it was.

The room was larger than any room in Iowa General, but it was crowded with medical equipment, some of which lined the walls while others crowded near his bed. The bio monitor was huge, nearly filling the wall above his head, but there was another display on wall to his right that was currently inactive. His high-pitched wheezing was a counter note to the chorus of hums and beeps the medical equipment was emitting. The amount of noise carried its own ominous message.

He shivered slightly. Why did they keep it so cold in here? He pressed his hand against his chest, trying to ease the sharp ache in his lungs. He was tired… so tired. Fatigue overwhelmed him, and he closed his eyes.

“Jim, wake up.” A hand shook his shoulder.

He opened his eyes to see a fuzzy image leaning over him. He couldn’t make out the face, but he knew the voice. Bones.

“Jim,” Bones said sharply. “I need you to wake up, kid. Come on.”

The hand shook his shoulder, relentless. It was difficult to breathe and the pain in his chest had spread. He blinked, trying to focus on Bones’ face. As his vision finally cleared, he realized Bones was not the only person at his bedside. A woman with black close-cropped hair stood next to Bones. Neither of them looked pleased. Bones was scowling down at him. Well, fuck Bones. He felt exhausted and he didn’t want to listen to any more pep talks. He let his eyes drift closed.

“No. Keep your eyes open. Jim. Stay with us.”

Another rough shake of his shoulder caused the pain deep in his chest to bloom. He moaned and opened his eyes. Bones’ eyes were dark and worried, focused intently on him.

“I know you’re tired. But you have to wake up now.” Bones’ cold hands cupped his face. “I need you take some deep breaths, Jim.”

Everybody always wanted him to breathe. He took a half-breath, the sharp pain in his chest cutting the attempt for a full breath short.

“Another one, Jim. Try to make it deeper, kid. I need you to breathe deeply.” Bones sounded insistent. Urgent. “You’re not getting enough oxygen.”

That didn’t make any sense, but he did as he was instructed, hoping Bones would go away and let him sleep if he obeyed. But the doctor didn’t budge. For the next few minutes, Bones continued to urge him to breathe deeply, occasionally looking at the monitor, his eyes concerned. The pain in his chest continued, but his head cleared, and the room seemed to come into better focus. Bones must have noticed, because he let go of his shoulder with a final, encouraging squeeze. Looking satisfied he straightened, still studying the monitor.

The dark-haired woman said something to Bones he couldn’t catch and they both nodded.

“Better?” Bones asked.

Than what? It still hurt to breathe and now the ache in his chest was constant and deep. He shivered and pressed his right hand to his chest.

“I know that wasn’t pleasant or easy,” Bones said, glancing at the hand Jim had pressed to his chest. “You have to keep breathing deeply, Jim, even if it hurts, kid. We don’t want you developing pneumonia. Understand?”

He scowled. He wanted to ask Bones why he was still in the hospital. Why it was hard to breathe, but he didn’t have enough air in lungs to speak.

“Jim?” Bones prodded.

Reluctantly, he nodded, knowing Bones wasn’t going to give up until he had his answer. He was persistent and stubborn bastard. And it wasn’t like Jim could just walk away or charm his way out of answering the question. He was tethered to the damn bed and too weak to resist even if he tried. A shiver tore through him.

“Cold?” Bones grabbed a blanket from the nearby warming cabinet and spread it over him. The heat felt wonderful.

The dark-haired woman had moved to the opposite side of the bed while they spoke, waiting silently. Jim looked at her.

“This is Lara,” Bones said. “Your respiratory therapist. She’s going to help you get your lungs back into shape.”

Lara smiled.

His head had cleared, and his thoughts were sharper now. Bones’ presence and his words suddenly made sense. He reached for the oxygen mask, wanting it off so he didn’t have to speak so loudly to be heard, but Bones quickly prevented him from removing it.

“That has to stay for now, Jim. Sorry.”

He tamped down on his frustration, hating the fact that his body needed to rely on the suffocating mask, and took a few wheezing breaths before he spoke. “Why’s it… so hard… to breathe.” His words were little more than a hoarse whisper.

Bones sat at the edge of the bed, his expression sad and soft. “The medication I gave you caused you to have a severe allergic reaction. Do you remember me telling you about that? Your lungs shut down completely due to the anaphylactic response, and they’re still somewhat inflamed.”

Jim scowled. He’d had anaphylaxis before, but this was different. He’d been in the hospital for days and still couldn’t breathe. “How long… until they’re… better?”

Bones looked sympathetic. “They’ll return to normal in time but it’s going to be a slow process.”

A slow process? What was Bones implying? If he couldn’t breathe, if his lungs didn’t get better soon enough, he’d get kicked out of the Academy on a medical discharge. He was on thin ice as it was. Pike had pulled some strings with his medical history, had promised him that everything was going to fine, that his adolescent allergies weren’t a cause for concern. Now because Grady had to put a fucking knife into his leg, he was going to get kicked out. All his plans would be for nothing. He’d have to go back to fucking Iowa. To nothing.

Bones looked up at the monitor with a scowl then back to Jim with concerned eyes. “Calm down, Jim. Your heart’s racing, and you’ll only make it harder to breathe. Everything’s all right. You’re going to be fine.”

But he couldn’t calm down and everything wasn’t fucking all right or he’d be on the back of his bike or fucking some hot Orion instead of lying in Medical. A wave of heat caused his face to flush, sending beads of sweat running down his face. His right leg flexed, as his body prepared to launch itself off the bed. To run.

Bones put a cool hand on his shoulder. “Steady now, kid. I want you to concentrate on your breathing. Nice deep, slow breaths. That’s the way, Jim. I need you to try and lower your heartrate.”

Bones was talking to him in a low, calm voice, the way his grandfather used to talk to the horses on the farm when they were spooked. He didn’t want to listen, but his heart really was racing, and it made his chest ache more, and he was gulping in air through the mask like a drowning man. Bones’ voice became his lifeline and he found himself following Bones’ instructions like he’d been hypnotized. Bones continued to talk to him soothingly until his heart finally slowed its thunderous beat against his aching chest.

“That’s better.” Bones glanced briefly at the monitor. “Listen, Jim. I know what you’re thinking. This isn’t the end of Starfleet for you, I promise. Your lungs are going to recover. You’re improving every day. They just need a little more time. Okay?”

Bones was a cantankerous bastard most of the time, but he’d never lied to Jim. Drawing one labored breath after another, fighting to get a full breath and feeling exhausted while he was simply lying in bed, didn’t feel as if he was making progress though. He grimaced in frustration.

Bones’ mouth tightened before he spoke. “Lara is here to help you with some therapy.”

Jim immediately switched his gaze to her and noticed that she was holding two small objects, no bigger than a communicator. He frowned at them, feeling his sense of foreboding grow.

She began to talk in a calm, clear voice. “These devices are inspiratory stimulators. They’ll help your lungs, especially the lower lobes, the bottom part of your lungs, to fully expand. Fully inflating your lungs prevents fluid from building up. The stimulators are an important adjunct to your recovery, especially while your airway is still inflamed. I’m going to place them on each side of your chest. They’ll utilize your existing nerve pathways to stimulate your diaphragm and the intercostal muscles, and the end result will be a nice deep breath, kind of like the ones the ventilator supplied, but without the invasive breathing tube.”

Bones pulled down the blanket and sheet to just below his ribs, exposing his chest. A waft of cool air washed away the little warmth he’d managed to find, and he watched suspiciously as Lara attached each device high on the side of his chest, uncomfortably close to his armpits. He’d been a dirty, sweaty mess when he’d arrived in the ER. The oxygen mask made it difficult to smell anything and he hoped the nurses had run a sonic over him at some point or he was probably pretty ripe by now.

The devices felt cold and annoying against his skin. Bones hadn’t moved from his position at the side of the bed and he kept a hand on Jim’s shoulder throughout the attachment process, studying him with the remote clinical expression Jim had come to be wary of.

Lara straightened, and Jim watched as she picked up another small device, the size of tricorder. “This control unit will send a signal to the stimulators attached to your chest. It’s not painful but you may feel a faint pulse or tapping sensation against your skin. I set the level on low to begin. Initially, the devices will only stimulate your lungs to take a small breath. We’ll increase the amount of stimulation only as much as you’re able to tolerate it, but the goal is deep, full inhalations. Do you understand?”

He blinked and nodded. Like he had a choice. Bones watched, his gaze intense.

“Ready?”

Before he could nod, a pulse went through his chest and his lungs inflated in a breath slightly deeper than he’d been taking on his own. The muscle movement caused a sharp pain of reaction deep in his chest as his lungs abruptly expanded. He grunted at the unexpected pain. Not hurt, my ass.

“Good,” Lara said encouragingly, watching the monitor. “We’re going to do a few more.”

He was about to say something when the pulse went through him again. Fuck! He closed his eyes as his lungs inflated, pulling and stretching the tender tissue deep inside.

“You’re doing fine, Jim.” Bones hand was a constant on his shoulder, thumb rubbing slowly back and forth in a gentle sweep. “Just try to relax and let your body respond. Don’t tense up.”

Another pulse. His lungs expanded… and so did the pain. He barely had time to brace himself before the next pulse hit him. Instinctively, he reached out for the control unit that was causing his pain, intending to turn it off, sweep it to the floor, anything to make the pain stop, but Lara caught his flailing hand at the wrist and restrained him.

“It’s all right, Jim,” she said. “Just a few more cycles.”

Another pulse.

He opened his eyes and looked at Bones, who stared down at him with an impassively. Jim was desperate for it to stop, but he couldn’t seem to get enough air to speak.

“We’re almost done,” Bones said soothingly.

Jim reached blindly for Bones’ arm, feeling the warning pull of the IV in his hand. Bones instantly removed his hand from his shoulder and caught Jim’s hand in a tight grip.

“You’re doing good, kid. One more,” he promised.

Jim barely felt the last pulse. His chest was radiating shards of pain and his head was buzzing. Fuck!

“We’re all done,” Lara said. “You can rest now, Cadet Kirk. You tolerated the therapy quite well. Good job.”

Jim closed his eyes, shutting himself away from her meaningless chatter, as she removed the devices. She said something to Bones but the words were drowned out by his wheezing lungs, the sound filling his ears, as he concentrated on breathing again. Releasing Bones’ hand, he rubbed uneasily at his throbbing chest. This torture was supposed to be helpful?

When he finally managed to open his eyes again, Lara was gone and the ache in his chest had subsided to a more tolerable level. Grimacing, he let his hand fall back onto the bed where he flexed his cramping fingers. Exhaustion was a smothering blanket.

“I know that was uncomfortable,” Bones said, pulling the blanket up to his chin. “But it’s vital we keep your lungs clear. Try to get some rest so you’re ready for the next session.”

He scowled, shivering. “Next?”

Bones looked sympathetically at him. “Yeah. You’re going to need to do this every few hours.”

He shook his head.

“Yes, Jim.” Bones’ voice was stern. “It’s necessary if we’re going to get you back on your feet as quickly as possible. Your lungs will get stronger with each session. Trust me.”

His head pounded, and his chest felt like someone was stabbing him with sharp knives. Fucking allergies. He hadn’t had an attack like this since he was kid. It couldn’t have come at a worse time. He wanted, intended, to finish the Academy in three years, and now this. What was Pike going to say?

“Get some rest,” Bones repeated, watching him, his face tight-lipped.

Jim looked up at his friend. There was a lot he needed to say. He wanted to tell his friend about everything from how he’d done in maneuvers, to how he’d almost finished first and broke the Academy record, to his concerns about Pike, who was closely monitoring his progress at the Academy and, now, his fear of not getting better soon enough to meet the Academy’s expectations. But he didn’t have the energy. Suddenly, his eyes were closing against his will, the room noise receding. Before everything went dark, he felt a cool hand on his forehead.

“It’s going to be all right, kid.”

* * *

McCoy leaned his right hip against the counter and held the cup of freshly brewed coffee to his lips. The real stuff. Not the replicator crap that passed as coffee. It took longer to make and was far more expensive, but the time and money was worth it. Inhaling the intoxicating aroma before taking a slow sip, he closed his eyes, letting the hot brew fill his mouth, and linger on his tongue, before swallowing.

It was his first real cup of coffee in a week. Still keeping his mug close to his mouth, he looked around his dorm room, seeing it with fresh eyes after his absence. Larger than the usual first-year cadet rooms, his room was a mini-apartment of sorts, equipped with a kitchenette, a sitting area and an enclosed bedroom. A small desk was positioned in the sitting area, the surface tidy. He hadn’t spent much time here since Jim had been admitted, using the hospital on-call facilities to grab a quick shower and shave, and put on fresh scrubs, afraid to leave Jim long enough to return home. Last night had been the first time in days that he’d slept a full night in his own bed, naked between clean sheets, uninterrupted by nurses reporting changes in Jim’s condition.

He took another unhurried sip of coffee, enjoying the quiet solitude, letting the peace soothe his frayed nerves. He was freshly showered and dressed in medical fatigues, because Boyce had given him another lecture on coming into the hospital in civilian attire— even though, technically, he wasn’t on active duty since it was the semester break, and it was the middle of the fucking night. Prick. Jim was his only patient, though he’d provided consults on a few trauma surgeries because, as Boyce had said, he needed something to occupy his time when he wasn’t directly involved in Jim’s care. Not exactly the leave he’d envisioned, but then it wasn’t for Jim either.

The respiratory therapy, though difficult and painful for Jim, was paying off. They’d finally managed to get Jim off the oxygen mask and onto a nasal canula late last night. His final report of the day to Pike on Jim’s progress had quickly produced a comm call from the Captain, as if the news had been too good to be true. Pike had been his usual inquisitive self and more optimistic than McCoy felt was prudent. He had cautioned the Captain that Jim still had a long recovery ahead of him.

Before McCoy had stepped into the shower this morning, he’d gotten an update on Jim and had learned that the young man had slept comfortably throughout the night, waking twice to request a drink of water. Jim’s low-grade fever and other vitals had remained stable.

McCoy glanced at his chronometer. Jim should have eaten his breakfast by now and with luck, they’d be able to get him out of bed today, get his circulation moving and test his repaired leg. Having a patient in bed for days on end caused its own problems and getting Jim on his feet as quickly as possible would only increase his chances of getting out of Medical while he could still enjoy some of his year-end leave.

McCoy lingered another fifteen minutes before shoving off the counter and heading toward the medical compound. He walked across the campus with firm strides, feeling the sun hit the back of his exposed neck. The damn military hair cut still made him feel like a newly shorn sheep. Unlike Jim, he hated the grooming regs required for the cadets. He ran a hand along the back of his neck, feeling the tiny hairs stand on end. His hair grew so quickly. It wouldn’t be long before he needed to visit the barber again if he didn’t get off Academy grounds soon for his break.

By the time he arrived at the east wing, where the ICU was situated, he felt invigorated. The walk in the fresh air had done more to revive him than four cups of coffee. He hadn’t realized how much he missed the regular activities he was accustomed to performing. He and Jim usually hit the gym together a few times a week. Staying on-call and tending Jim as he had over the past few days was beginning to manifest itself in stiff muscles and easily triggered fatigue. He made a mental note to visit the gym tonight.

As he turned down the corridor to Jim’s room, he saw Sidra standing just outside Jim’s door, pacing nervously back and forth. The unusual sight caused a sinking feeling in his stomach. He hadn’t been notified of any urgent changes with Jim but he increased his pace anyway.

“What’s going on?”

Sidra spun to face him, startled.

“Dr. McCoy. I was just about to call you.”

“What the problem.” Jim’s door was closed, and the privacy screen was activated.

“Captain Pike is here,” she said flatly. “He kicked me out of Cadet Kirk’s room to they could speak privately.”

_What the hell?_

“He kicked you out?” McCoy growled incredulously, staring at the closed door then back again to Sidra. “Doesn’t he understand that you are providing necessary medical care to a patient?”

She shrugged, looking both sheepish and angry. “He outranks me. I didn’t have a choice.”

“Like hell.” He pushed through the door. Privacy screen or not, no doors locked on the ICU ward. Jaw set, he strode in to find Pike sitting in the spare chair next to Jim’s bed, his back to McCoy. Jim was nearly upright, listening intently to whatever Pike was saying. Pale and drawn, the nasal canula made him appear vulnerable and unwell— which any fool could see he was. A tray of uneaten food rested nearby, and McCoy silently fumed at the sight.

Walking to the opposite side of the bed, he stopped near the foot where he could most easily see both men’s faces. They had stopped talking— whether that was because of McCoy’s interruptions or a natural pause, he didn’t know and didn’t care— but neither man acknowledged his presence which irritated him even more.

“Captain,” he said shortly, hoping his cold tone would get Pike’s attention.

Taking his time, Pike turned in his seat. He looked at McCoy as if he had just joined their table for two, uninvited, over lunch in the officer’s mess. McCoy bit down on the urge to remind Pike that he was in the fucking ICU, which was _his_ territory. 

“Doctor,” Pike said, acknowledging him with a thin smile. “I hope you don’t mind. Jim and I were just having a chat.”

“He’s still recovering, sir. Talking is stressful for him.” As if Pike didn’t already know that.

Pike held his gaze for a moment longer, then stood. “I thought Jim could use a little company, get caught up on current events. But I take your point, Doctor. I’ll get out of your hair. For now.” He turned his gaze back to Jim, who had lapsed into a sullen silence. “I hope I didn’t tire you out, son.”

Jim looked at up him with overly bright blue eyes. “No, sir.”

Pike nodded, then, giving McCoy a brief look, turned and began walking out. “I’ll expect your reports to be on time,” he said to McCoy before he pushed open the door and left.

McCoy clamped down on his irritation and turned his attention to Jim. Dressed in a white hospital gown, his color as pale as the sheets, surrounded by medical equipment and hooked up to different monitors, Jim looked impossibly young and defenseless. “You okay, kid?”

Jim’s brows rose slightly and he sighed, leaning back into the mattress, and resting his head into his pillow. “Relax, Bones. It… wasn’t an inquisition.”

McCoy studied him silently. Jim looked exhausted and his voice was faint and a little breathless. He no longer wheezed constantly, but his lungs were nowhere close to being healed. “Then why did he kick my nurse out?”

Jim didn’t respond. 

Sidra entered, giving McCoy an apologetic look as she handed him Jim’s chart, before moving to Jim’s bedside and beginning a check of Jim’s various intravenous and oxygen lines, as if she wanted to be sure Pike hadn’t disturbed anything. While she did that, McCoy took the opportunity to review the latest data entered into Jim’s chart and confirm what he’d been told hours earlier. No spike in his temperature, blood pressure was normal and O2 sats were within acceptable ranges, respirations a little high, but nothing unexpected or alarming.

Completing her patient check, Sidra came around McCoy’s right side and reached for the untouched food tray.

“Leave that,” he ordered her without looking up from the chart.

She nodded and exited, leaving them alone in the room.

McCoy reached over and grabbed the tray, swinging it around to place it in front of Jim. “Eat.”

“Why are you mad… at me?”

He looked up from the chart to meet Jim’s gaze. “I’m not mad at you, Jim. You need to rest in order to recover. For the past five days you’ve been fighting to breathe and you’re not out of the ICU yet. The last thing you need right now is a visit from the Academy Commandant to review your performance.”

“Pike was just making… a point, Bones.”

“And what point was that?”

Jim said nothing staring obstinately at him. Jim didn’t look angry or upset, just uncharacteristically unreadable, which worried him. Jim had been an open book to him over the past year, easy to talk with, shamelessly self-confident, inquisitive, frighteningly intelligent and, for the most part, easygoing. But he’d never have called his friend distant. Jim spoke his mind— often and freely. What had Pike said that had made Jim withdraw behind a silent mask? He sighed and nodded toward the tray. “You need to eat some of that.”

“I’m not hungry.”

McCoy’s eyebrow arched. “I didn’t ask if you were hungry. You’ve been surviving on IV solutions since surgery. Your system been depleted of nutrients. You need to eat, give your body some solid food to work with in order to sustain the healing process.” He paused, keeping his gaze level. “Unless you want to prolong your stay here?”

Reluctantly, Jim looked down at the tray and picked up a fork.

Satisfied, McCoy returned his attention to the chart and wrote out his orders for the day. He renewed the breathing treatments that Lara was providing, and asked her to focus on working to get Jim off the supplemental oxygen altogether. Another notation, requesting the nursing team to push oral hydration. An order to dietary, to provide high protein, high calorie between meal snacks. In addition, he requested a visit from the nutritionist to discuss food preferences. Hospital food was notoriously bland and unexciting. The least he could do was to ensure that Jim be allowed to select foods he preferred while still meeting basic nutritional requirements. Lastly, an order to Physical Therapy to do an in-room assessment in preparation for initial ambulation following surgery.

Jim put his fork down and pushed the tray away. McCoy noted he’d eaten about quarter of the food, which was a good start. Grabbing the tray stand, he swung it out of the way and sat in the chair Pike had vacated. “We’re going to get you out of bed today.”

Jim’s eyes lit up. “Really?”

“Really.”

Jim’s gaze immediately went to the door and McCoy could see his wheels turning.

“Into that _chair_ ,” McCoy said sternly, pointing to the patient chair in the corner.

“Come on, Bones,” Jim pleaded. “I’m tired of staring at these four walls.”

“Don’t ‘come on, Bones’ me. You just got off the oxygen mask and your lungs are better but they’re nowhere near healed. I’m not going to risk a setback. Ambulating in the room is good enough to start.”

Jim pulled back the covers and made as if to get up.

“Not now.” He got out of the chair and pulled the covers back over Jim’s shivering body. “Respiratory therapy first.”

Jim moaned, and his expression fell. “How much longer do I have to … have those treatments?”

Looking at Jim, sympathizing with his disappointment, McCoy said, “Another day or two, if everything goes well.”

“Fuck,” Jim said softly. His enthusiasm for getting out of bed had been wiped away by his despondency, along with his energy. “There are… rules against torture, you… know.”

Jim wasn’t the first patient to say as much. Critically ill patients often reacted to necessary treatments— treatments that were often invasive and painful— with resistance and anger. McCoy didn’t take it personally. In fact, in his view, if a patient had enough mental and physical energy to resist, to get angry, it was a good sign they were on the road to recovery.

“I feel better, Bones. Good… enough to get out of bed.”

And not able to finish two sentences without running out of air. “It’s not negotiable, kid.”

Jim growled in frustration and lightly kicked out with his good leg.

“Get some rest. I’ll be back later.”

* * *

It was early afternoon before they managed to get Jim out of bed and into a chair. The respiratory session had exhausted Jim, and he’d fallen into a deep sleep soon after.

“Ready?” McCoy asked. He stood next to Jim’s bed with the physical therapist and Troy.

“Hell, yeah.” He was sitting up in bed, away from the cushioning bulk of the pillows, feeling the chill and ache of the fever he couldn’t seem to shake. His hair was sticking up in several directions and the nasal canula was tucked securely under his nose. He hated it, but any time he’d try pull it away his body quickly felt the absence of oxygen and he’d end up greedily breathing in the soft puff of air.

Moving a patient in his condition was not easy apparently. Jim tried to be patient as the medical personnel dealt with his various tubes and lines. The nasal canula tubing had to be hooked up to a portable oxygen unit, which Lara had provided earlier. Troy had temporarily disconnected his IVs, capping the open lines and plugging the catheters in his veins with heparinized locks. That had been a little uncomfortable, but nothing that he couldn’t tolerate.

Sori, the physical therapist, moved to stand on Jim’s left side. Humanoid, but not human, she had a solid, muscular frame and could easily take Jim’s weight.

“Take it easy putting weight on your left leg,” Sori said to him. “Those muscles haven’t been tested yet.”

Jim didn’t waste his breath acknowledging her cautions, focusing instead on positioning himself closer to the edge of the bed – like a caged animal about to be set free. His leg was more uncooperative than he’d expected. He hadn’t had the chance to do much with it over the past few days, so he hadn’t realized until now how much his leg ached when he tried to move it or how difficult it was to coordinate its movement. He could barely lift it off the bed. It was a weighted thing that ached and throbbed.

Seeing his difficulties, Sori carefully took Jim’s uncooperative limb in her hands and helped him ease it off the bed. “That feel all right?”

Jim nodded. A wave of dizziness caused him to sway.

“Take a couple of deep breaths,” McCoy said. He’d come around to Jim’s right side and steadied him with a firm hand. “This is the first time you’ll be vertical since the accident. I don’t want you passing out.”

“’m not gonna pass out,” he said affronted, but did as he was told when the breathlessness remained. After a few deep breaths, the dizziness disappeared but his heart still hammered, sending a fine tremor through his body.

“As we stand you up, try and put most of your weight on your right leg, Jim,” Sori instructed.

McCoy and Troy nodded to each other and, hooking their arms under Jim’s, slowly hoisted him to a stand. Jim leaned heavily on McCoy, feeling hobbled and trying to get his bearings.

McCoy tightened his grip and adjusted his stance to take more of Jim’s weight. “Take your time, kid. Let us know if you feel dizzy.”

But Jim wanted to move. He took a step forward with his right leg and found he had to drag his left in order to complete the step. The limb felt heavy and useless. Pain throbbed deep inside the healing muscles.

“That’s good,” Sori said. “Try to lift your left leg a bit more but keep most of the weight off it.”

Jim tried to do as he was told, but lifting his leg was an enormous task. The muscles in his thigh bunched and tightened, balking at obeying his commands. He was like a newborn learning to walk, clumsy and uncoordinated.

Another step. McCoy was taking more of his weight. His injured leg flexed stiffly, and the pain grew more pronounced.

“Want to stop?” McCoy asked. His fingers were firm on Jim’s hip, his grip secure and reassuring.

Fuck no. He wasn’t going to stop. He’d finally gotten out bed. It was ten feet to the damn chair. Ten lousy feet. He shook his head, knowing he didn’t have enough air to speak. His heart was hammering rapidly against his chest. His vision had narrowed to a single spot a little more than a foot in front of him. Nothing else seemed to exist, except for that limited view and McCoy’s steady grip. By the time he got to the chair, he was sweating and wheezing for air. They lowered him down just as his strength gave out completely. He sank into the cushions, limp with exhaustion, his spine curled and shoulders hunched forward in a bid for more air.

“Dizzy?” McCoy asked. He knelt beside Jim and took his pulse as Troy repositioned the pillows to better support his upright body.

McCoy’s voice seemed to come from very far away. Jim couldn’t find his voice, staring blankly at the floor, as sweat ran down his face, barely aware of the cool puff of oxygen under his nose… or that he was wheezing.

“Jim,” McCoy said more loudly. “Do you hear me?”

The sweat cooled on Jim’s face and he felt his heartrate ease. “Yeah?”

“Increase the oxygen,” McCoy ordered.

“He’s at two liters currently. What amount do you want?” Troy asked.

“Turn it up to five liters. You can wean him back down to two, once he’s resettled in bed.”

A cool cloth wiped away the sweat on his face. After a few deep breaths, Jim slowly began to come back to himself, feeling washed-out but more clear-headed. He was no longer wheezing, but was acutely aware of the pain in his leg.

McCoy was studying Jim closely, feeling the pulse slow beneath his fingers. “Better,” he said on a note of relief. “Just keep breathing deeply and slowly.”

Jim managed to straighten his spine, although he still needed to lean his elbows on the arms of the chair that suddenly seemed too big. He concentrated on his breathing, as McCoy had instructed, until the pain in his leg couldn’t be ignored any longer. He rubbed his thigh, trying to appease the radiating pain that was cramping the muscles. His efforts only intensified the growing agony.

Sori knelt next to his injured leg and gently removed Jim’s hands. “The incision is still tender. Rubbing it will only make the pain worse.”

Jim tried stretching his leg out to ease the cramping, but the muscles pulled tighter in warning, and he hissed in pain.

“Hold on,” Sori said and began to massage Jim’s calf, taking her time to loosen the muscles. “Doc here did too good a job on your quad. The repaired muscles will need to be stretched regularly in order to regain their flexibility.”

“They’re just tight,” Jim said faintly. A headache had started behind his eyes and his chest ached, so his leg was just another area of discomfort. He leaned his head back against the chair, trying to find relief.

Sori looked skeptical but kept firmly massaging the calf muscle before slowly moving upward to his thigh.

“Just rest and enjoy your new perspective on things,” McCoy said, finally letting go of his wrist to stand. “You did good.”

Jim snorted weakly.

“First time out of bed is always the most difficult. It’ll get easier.” McCoy put a reassuring hand on his shoulder.

But Jim wasn’t so sure. He’d barely made it across the ten feet of floor to the chair. And if McCoy hadn’t been holding him up, he wouldn’t have made it at all. He’d thought his biggest problem was his lungs, but after trying to put weight on his leg, he’d realized he didn’t have the strength to stand, unaided.

Fucking Grady.


	5. Chapter 5

The unrelenting buzz woke McCoy from a sound sleep. As a doctor, he’d developed the requisite sleeping habits of a medical professional, often pulled out of his slumber by an urgent medical call that required his attention. No trauma surgeon worth a damn couldn’t go from dead asleep to dead awake in the space of a heartbeat. When he had to respond, it had to be with his head screwed on straight, and he had to be ready to get dressed and move on a moment’s notice. Sometimes, if he was lucky, it was something he could handle remotely, prescribing over the comm link, and go back to sleep. He’d also learned the knack of easily falling back to sleep after being awakened, in case the fates were willing to grant him a few more hours of sleep— something he’d learned the hard way, as an overworked resident early in his career. With his eyes closed, he reached for the comm on the nightstand and flipped it open. “McCoy.”

“Dr. McCoy, it’s Keri. I’m sorry to wake you.”

He opened his eyes in the dark bedroom and raised up onto an elbow. Keri was the night shift ICU nurse. He’d never known her to overreact and wake him unnecessarily. “What’s wrong?”

“There’s a private caller demanding to speak to you.”

He immediately fell back onto the bed, limp with relief. Not an emergency with Jim. Nothing medical, in fact. Just a caller. And it obviously wasn’t a personal call. His family wouldn’t call the hospital looking for him. They had his private comm number. “What time is it?”

“0233.”

“Take a message.”

“Doctor, it’s Commander Kirk— Cadet Kirk’s mother. She’s on a direct link from the _USS Lexington_ in the Gamma Quadrant. She’s demanding a vid conference with you. I told her it was the middle of the night and that you were off shift, but… she’s very insistent.”

_I’ll just bet she is._

He sat up, sleep fleeing, as his brain kicked into gear. Jim’s mother? How the hell had she heard about Jim out in the black? There had been no order on Jim’s personal record to notify his next of kin of anything other than death. And even that was a pro forma, after-the-fact notification. Why the hell was she calling him and not Jim? “Give me three minutes and send it to my personal comm.”

“Yes, Doctor.”

He terminated the call and growled, “Lights, eighty percent.”

Blinking against the abrupt glare, he rolled out of bed, and headed for the bathroom. If he was going to speak with Jim’s mother, he needed to be alert. He splashed cool water on his face to erase the last remnants of sleep and took a quick look in the mirror. He looked tired and worn, but it was the best he could do at two o’clock in the morning, on four hours of sleep.

Clad only in a black tee and boxers, he made his way to his desk, finding no reason to change into clothes for the call. The comm would only show his image above his pecs anyway. Commander Kirk was the one calling in the middle of the night; she could damn well deal with him being out of uniform.

The comm was blinking, waiting for his acceptance input when he sat down. He hit the link and the image of a woman instantly appeared, staring intently at him as if she had known he was going to key on the screen at that very moment.

He was surprised by her delicate beauty. He wasn’t certain what he had been expecting, but this refined, polished woman wasn’t it. She had blue eyes, though they weren’t as blue as Jim’s, he noticed. Her blond hair was pulled back into a loose pleat, and she was in uniform, though from the view behind her it looked as if she was in her quarters.

“Doctor McCoy?” She straightened in her chair and leaned back slightly, as if his image was unexpectedly overpowering.

“Yes, ma’am.”

“I’m Winona Kirk, Jim’s mother. I apologize for the hour, but it was the only time I could get a direct link to Earth.” Her voice was pleasant on the surface— it was melodious and feminine— but beneath it, McCoy detected a tone of steely command.

“Apology accepted,” he said easily, although his instincts were suddenly on alert. “What can I do for you, Commander?”

“I understand you’re Jim’s attending physician.”

He nodded, studying her, noting the smooth, milky skin. He could see where Jim got his fair complexion from, but otherwise the resemblance ended there. “I am.”

She passed a tongue over her lips, just the way Jim did when he was nervous. “I was told he was injured.”

He said nothing, thinking hard. In Starfleet, the administrative brass were exempt from doctor-patient privacy laws. But that wasn’t true for family members and other interested parties. Commander or no, Jim had not given him permission to speak to her about his health. “Uh… I’m sorry, Commander. I can’t discuss Jim’s condition with you due to patient confidentiality rules.”

“I’m his mother.”

“I understand that, ma’am.”

He saw anger in her tightly controlled features, the set of her jaw.

“I’ve already been informed that he was hurt during maneuvers, and that he had a severe allergic reaction to medication. Medication, as I understand it, that you prescribed.”

So, it was going to be that way. Speaking frankly to family members about the health of their loved one came with the job. As did _not_ speaking to family members, depending on the patient’s wishes. Jim wasn’t the first patient he’d cared for who’d put a privacy seal on his health records. Family members tended to think they had more rights than the patient, especially in times of crisis, and when faced with the reality of their limitations, often became angry when their wishes were balked. A classic case of shooting the messenger.

He didn’t bat an eye as he spoke. “I understand your concern for your son, Commander, but I really can’t discuss Jim’s status with you. You’ll have to contact Jim directly. If he gives you permission to be updated, I’ll be more than happy to have a discussion with you.”

She leaned forward, her image dominating the screen. “I wouldn’t be waking you up in the middle of the night if my son would take my comms, Doctor.”

Now that was interesting. Jim was tight-lipped about his mother— hell, he was tight-lipped about his personal life, in general— but McCoy hadn’t sensed any anger in his friend on the rare occasions Jim’s life before Starfleet came up in conversation. He’d gotten the impression that Jim and his mother were estranged and, out of respect for Jim, hadn’t prodded the kid for details. McCoy knew a few bare facts: Winona Kirk was in Starfleet, was frequently on assignment in deep space, and had been since Jim was a child. The one time he’d asked Jim about his mother, the young man, looking cool and distant, had shrugged his shoulders and replied that she hadn’t been around much when he was growing up. It hadn’t occurred to McCoy that they didn’t speak at all. Now his brain was buzzing with questions he desperately wished he knew the answers to. He wondered how often, if any, she had tried to contact Jim? He’d been at the Academy for a year. Was she happy with his enlistment? Proud? Angry? Worried? Or fearful he might be killed? Had she been checking on his progress, regularly, with someone funneling information to her through back channels?

“I really can’t help you, ma’am.”

“He can react badly to medications,” she said steadily, ignoring his comment. “He’s been difficult to treat safely since he was a child. As his physician, you should have known that.”

McCoy said nothing, refusing to take the bait. She wasn’t the first concerned parent he’d been up against in his medical career.

“Is he still unable to breath on his own?”

Enough of this. He was tired.

“Listen, Commander, I don’t know how you found out he was injured.” Although he had a pretty good idea. “But as a physician, I am legally required to follow the laws governing private medical information. Jim is an adult, and as such, he has clearly stipulated who is allowed to be informed about his health.”

She met his gaze with unwavering determination. He could see where Jim got his stubbornness from.

“I already know he was injured and he went into anaphylaxis, which shut down his lungs. I know that you’re having trouble getting the pulmonary inflammation under control, and until that problem resolves, Jim’s lungs are compromised.”

McCoy controlled his visible reaction to her words, clamping down on his stirring anger. She was voicing the exact words and phrases he’d used in his reports to Pike. “Sounds like you don’t need me, ma’am, since you’ve already received a report.”

“I want to know how he’s doing, Doctor. Is he going to recover?”

There was an underlying note of maternal worry in her request, despite her demanding tone. He empathized with her, but… “I understand your concern, Commander, but as I’ve repeatedly said, I can’t discuss Jim’s past or current medical situation with you.”

Her eyes grew stony. “I can get an Admiral to order you to speak with me, if necessary, Dr. McCoy. I’m sure you’d prefer to avoid that.”

He pursed his lips, undaunted by her threat. “My preferences aren’t the issue here, ma’am. I’m sorry. As for your threat of going over my head, well, I can’t stop you. But if you do try to get hold of that Admiral, Commander, I’d advise you to wait until morning. The higher-ups tend to be cranky and uncooperative when people wake them before dawn. Now, if there isn’t anything else, I’d like to find my own bed.”

He made a move to end the comm when she spoke.

“He’s angry with me,” she confessed, spitting the words at him like angry bullets, her nostrils flaring.

Christ, he didn’t want to get into the middle of a Kirk family quarrel. His own family situation was complicated enough. Who the hell knew what Jim’s history was? But there had to be a good reason that Jim never spoke of his childhood or his family. Jim was his friend. Even if there hadn’t been medical ethics to consider, McCoy intended to respect Jim’s privacy.

“Commander—”

“I wasn’t always there for him.” She looked away from the screen and her eyes grew distant. “Things… happened… that shouldn’t have.”

What the hell did _that_ mean?

Unsettled, McCoy watched her closely. The fight seemed to drain from her before his very eyes. He’d seen Jim react the same way when he was exhausted. McCoy knew the woman had spent the last thirty years in Starfleet, in deep space, by choice. It was difficult to reconcile that fact with the imagine of her as a mother of any kind. It hurt to realize that this hard-eyed and aloof woman was Jim’s mother. Rarely home, apparently focused on her career to the exclusion of all else, she must have had little love or affection to give to a young boy. Attention starved, Jim had to have craved what little time she did give to him.

McCoy had a sudden mental imagine of a tow-headed kid watching his mother leave, choking on his tears, pleading for her to stay just a little longer. What had made Jim stop caring if she was part of his life?

“I didn’t want him to join Starfleet,” she said distantly, but it sounded like a confession. “He knows that.”

So, they had spoken in the last year, at least. Or maybe not, McCoy suddenly thought. Winona Kirk would likely have made her feelings known on that subject from the time Jim was a young boy, not that he blamed her. He’d joined Starfleet to get away from a life that had been taken from him. Jim had joined Starfleet to get his back.

“Starfleet makes it difficult enough to be the widow of George Kirk. I can’t imagine what it’s like attending the Academy as his son,” she said, her voice barely audible, her dark blue eyes cloudy with emotion. “Why did he have to join?”

McCoy wondered if she realized she was speaking her thoughts aloud to him, if she’d ever shared her concerns with anyone else? He didn’t know what to say. He couldn’t give her the information she sought and he couldn’t validate her views on Jim either, so he remained silent.

“He’s going to be just like his father,” she whispered. In that moment, she looked incredibly vulnerable, and incredibly hurt.

The same thought had occurred to Jim, but only when he was too drunk to hold his tongue. But, apparently, Winona’s fear was that Jim would sacrifice his life the way his father had, while Jim’s fear was that he was never going to be good enough, never going to live up to the legend George Kirk had become. Maybe it was the physician in him, the natural tendency to heal that made him speak. “If it makes a difference, he’s happy, ma’am. And he’s exceling in his classes.”

She looked back at him and the cool, indifferent mask fell back into place, just the way he’d seen it do on Jim when he wanted to hide his true feelings. “I’m sorry I woke you, Doctor.”

“Comma—”

The screen went black.

McCoy slept soundly before waking at 0700. Yawning, he stretched, luxuriating in the quiet and the feel of the soft mattress for another ten minutes before he finally got out of bed. He took a long hot shower, rewinding the conversation with Winona Kirk in his head, wishing he could just forget it at the same time. Jim wasn’t going to be happy that his mother had contacted him, and he wasn’t certain how his friend would react when he learned of Winona Kirk’s call. Hell, he didn’t even know how he was going tell Jim, without upsetting the kid. Though McCoy had revealed nothing to Winona— despite being caught off guard by the middle of the night comm— it felt like a betrayal of sorts to have even conversed with her. He hoped Jim knew that, as both physician and friend, McCoy was firmly on Jim’s side.

Once clean and shaven, he poured a fresh cup of coffee and took a moment to check on Jim.

“He’s awake and alert,” Sidra said. “BP is 104/58 and respirations are 20. His temp is up a little, 100.6 He’s tired and a little listless this morning.”

All of which could be due to the exertion of getting out of bed twice yesterday. He took a sip of coffee. “How’d he sleep?”

“Night shift notes state he was awake a few times during the night. At report this morning, Keri said that he complained of some discomfort in his leg, but he went back to sleep easily enough after she applied a warm, moist compress to it. She offered pain meds and fluids each time he awoke, but he refused both.”

McCoy scowled, not surprised to hear that Jim’s leg was reacting to the demands of yesterday’s exertions. The first day of ambulating after surgery was always the hardest. PT had gotten Jim up and into the chair one more time yesterday before McCoy had left for the night. The second journey from the bed to the chair was only slightly more improved than the first. He’d left after seeing Jim safely resettled in bed, and the kid had fallen into an exhausted sleep seconds after his head hit the pillow. His vitals had been stable, both his pulse and respiratory falling back into normal range after being elevated by the exertion of walking. McCoy chewed on his bottom lip. Refusing pain medication was par for the course with Jim. But refusing hydration? That was a concern. If Jim wasn’t drinking, they couldn’t remove the IVs.

“Has he eaten?”

“He’s refusing to eat his breakfast, Doctor. He says he’s not hungry.”

McCoy sighed. “Push the oral fluids. Run the peripheral and the central line both at 125 cc per hour. And I want him on his feet this morning. Let’s try for a longer walk today and see how he does. Maybe it will stimulate his appetite.”

“Yes, Doctor. PT is supposed to be here by 0900. You want them to hold?”

“No, but give him some time to recover before his respiration therapy treatment. And see if you can’t get him to eat something before he’s ambulated. Offer him anything he wants. Something is better than nothing. I’ll be in an hour or so.”

“Yes, Doctor.”

McCoy closed the comm and went into the kitchen to retrieve his coffee. It was going to be a long day.

It was closer to two hours than one when McCoy arrived at the hospital. Pike had finally come to his senses and agree to let up on the every four-hour reports. He had agreed that twice-daily updates were adequate, giving McCoy more free time in the day. With Jim making progress and nothing too worrisome in the morning update, he’d decided to stop off at the gym for an impromptu workout.

He’d just hit the weights when Boyce had commed him. Evidently, Commander Kirk had been making her way through Starfleet channels and landed on Boyce.

_“She’s his mother, Leonard. You can bend the rules,” Boyce said._

_But he couldn’t, and he was pissed that Boyce thought he should._

_“Commander Kirk’s in deep space. There’s no way she can make it to Earth to be with him in person. We make accommodations for these things in Starfleet.”_

But did they with everyone, or just Winona Kirk? He’d argued with Boyce, determined to hold his ground, but the debate had been short. By the time Boyce had concluded the conversation, McCoy was so infuriated at Starfleet politics, he’d found the first punching bag he could and spent the next thirty minutes beating the hell out of it until he felt the tension that had gripped his body finally release. He was still pissed after showering and changing back into his medical fatigues. With angry strides, he’d headed to the hospital, hoping the walk would help him regain his equanimity.

He entered Jim’s room in a calmer frame of mind, only to hear his friend cry out in pain. Jim lay supine and Sori had his bandaged leg in her hands, pushing his knee towards his chest, stretching out the quad.

“Okay, try to relax, Jim. Let me do the work,” she soothed, not pressing the flex any deeper. She held the stretch, carefully supporting the leg, before easing it down to lie flat.

McCoy stayed back, not wanting to interrupt or distract her.

“Where do you feel the pain?” she asked.

McCoy couldn’t hear what Jim said in reply, but he saw Sori begin to firmly massage his thigh, moving her fingers slowly along the muscle from just above the knee toward Jim’s groin. After a few minutes she asked, “That better?”

“Fucking wonderful,” Jim said, his voice breathless.

McCoy could hear the exhaustion and irritation in Jim’s response. He gazed at the monitor above Jim’s head. The display showed Jim’s vitals were elevated, which was not surprising given the pain he was experiencing.

Sori stepped away and retrieved a small bundle. Returning, she unrolled it and laid it on Jim’s injured thigh. “This heat should help keep the muscles from stiffening up. Try to keep flexing your leg, pulling it toward your chest, even while you’re in bed. Moving it regularly will relax the muscle, and make using it easier and less painful.”

“Are we done?” Jim asked. He’d thrown an arm over his eyes.

“Yes, Jim, we’re done,” Sori said with a sigh. She pulled the blanket up to Jim’s waist and looked down at him. “Keep that heat on for at least thirty minutes. I’ll be back in a few hours and we’ll go for another walk, see if you can make it to the door, this time. There’s a whole world outside this room you haven’t seen.”

McCoy moved forward as Sori turned away from the bed. She nodded to him as she left the room. He took her spot, looking down at Jim. He was flushed and sweating, his breathing rapid and jerky. McCoy’s ears caught the faint sound of wheezing, but he ignored the monitor display, focusing instead on Jim, absorbing impressions instead of the raw data. The white hospital gown clung to Jim’s sweat dampened body and beneath Jim’s arm, he saw the flush on his cheeks. A rivulet of perspiration ran down Jim’s neck, pooling in the hollow of his throat.

“Good morning,” McCoy said evenly.

Jim didn’t move his arm from eyes. “Who says?”

McCoy winced. He couldn’t blame Jim. The injured quad was another layer of discomfort that he was having to endure, along with his slowly improving lungs.

The quad should have been stretched and worked twenty-four hours after surgery. Normally, initiating PT right away eliminated most of the discomfort of exercising newly repaired and regenerated muscles, but the anaphylactic reaction had made exertion of any kind impossible. The resulting delay had led to a quad that was tight and weak, making even the basic therapy more difficult.

“Chest hurt?” McCoy asked, seeing Jim’s free hand press against his chest.

“’sokay.”

McCoy studied him a moment longer listening to the faint sound of wheezing as Jim worked to calm his breathing. He didn’t want to prescribe an analgesic for Jim’s leg pain if he didn’t need to. “I’m going to incline the bed. It’ll help with your breathing.”

He tapped on the control panel and the head of the bed slowly inclined. Jim dropped his arm as the bed came to a stop at a gentle thirty degrees. The dangling IV lines brushed against Jim’s raised arm, the contact seeming to irritate him because he jerked his arm away from the lines with a grimace, letting it fall to his side on the bed.

With Jim’s face uncovered, McCoy could see the tension around the young man’s eyes and mouth. Now was clearly not the time to talk to Jim about his mother calling. McCoy sighed, and pulled the blanket up to Jim’s chest.

Jim roughly pushed it away. “I’m hot.” His lips twisted as he gazed down at his bandaged leg and the heating pad. “I don’t want that on anymore.”

Sidra entered the room and silently handed him Jim’s chart, giving McCoy a look that said she was well-acquainted with Jim’s current mood.

“You need to keep that on for a little longer, so that your muscle doesn’t spasm. The heat will help.” He studied the chart.

“When am I getting out of here?”

McCoy looked up from the chart. “When you can walk out under your own power and _without_ oxygen assistance.”

“What about this?” Jim asked, holding up his arm with the IV in it. “I don’t need this.”

“Yes, you do.” He returned his attention to the chart as Sidra checked the oxygen and IV lines. She left and he looked up from the chart. “Sidra said you refused breakfast. Why aren’t you eating?”

Jim met his gaze with a defiant look. “I’m not hungry.”

“If you want to get out of here, you need to eat. I can’t give you everything your body needs through an IV. You’re shedding too much weight, Jim. Inadequate nutrition saps your reserves, and hampers your body’s ability to heal and fight off infections. I don’t need you getting pneumonia or a leg infection because of your stubbornness.”

Jim held his gaze for a moment longer, his expression mutinous, before he turned his head away. His body was wire-taut, as he absently rubbed his chest.

Stubborn, pig-headed….

He turned his attention back to Jim’s chart and began making notes when a familiar voice froze him in place.

“Good morning, Jim,” Pike said.

McCoy turned toward the door, his earlier anger resurfacing as the captain entered the room, striding determinedly to the bed. Pike exuded confidence, as if he owned the whole damn room. As if it didn’t matter that Jim was still in the ICU with a No Visitors sign posted next to the door.

“You’re looking better, son. I heard you got out of bed yesterday.” Pike smiled down at Jim.

McCoy scowled as he stood silently by and watched the interaction, irritated anew that Pike had interfered in Jim’s recovery, ignoring McCoy’s medical orders.

“Yeah … all the way to the chair,” Jim said flatly, though sounding considerably more civilized than when he’d spoken to McCoy.

“Progress.” Pike nodded approvingly. “You’ll be out of here in no time and able to join your class when they resume. You did well this year, Jim. Exceptionally well. I’m proud of you.”

“Thank you, sir.” Jim shifted uncomfortably. “I’m feeling better.”

“Glad to hear it.” Pike smiled, his gray eyes sharply attentive. “Your instructors have recommended you for Advanced Strategic & Tactical Deployment. That’s a third-year course and a direct path to leading your own landing party.”

“Landing party?”

“You’re doing a tour on the _Farragut_ in six months.”

McCoy didn’t know what that meant, but Jim’s eyes lit up with an expression of appreciation and excitement.

“A starship tour.”

“Congratulations, son. That’s a highly coveted spot. Only six cadets are chosen a year. You’ll be the first second-year cadet to ever get a spot on a starship.”

McCoy couldn’t help his own swell of pride at Pike’s announcement. Jim had worked his ass off this year to accelerate his training and graduate within his self-imposed timeline. And, as Pike had said, he’d done exceptionally well.

“Thank you, sir,” Jim said. The flush in his cheeks had faded and a sickly pallor was settling in. “I appreciate it.”

Pike made a soft sound in the back of his throat, as if he’d swallowed a chuckle. “I didn’t do anything, Jim. This is all you. You worked hard for this.”

Jim looked embarrassed, a blush rising again to his cheeks. McCoy couldn’t help but be amused that the cocky, overly self-confident kid could be embarrassed by praise. The kid tooted his own horn more than the Academy band.

“Good news to share,” Pike said easily. “I’m sure your family will be proud, as well.” He paused, looking thoughtful. “I know your mother’s in deep space, but I can arrange a comm link, if you’d like.”

McCoy watched as the happy excitement bled from Jim. His face assumed a guarded expression and he shifted uneasily in the bed. “That’s all right, sir. I don’t want you to go to any trouble.”

“No trouble. We can set something up in here. You don’t even have to leave your bed.”

Jim’s respirations and heartrate steadily increased, the monitor readout climbing, and McCoy saw Jim’s shoulders tense.

“That’s not necessary,” Jim said flatly, in a tone that brooked no argument.

Pike studied Jim for a long moment before he spoke. “Jim… you should give your mother a call. She’s worried about you.”

And there it was, McCoy thought bitterly. Pike’s real reason for his visit— not to lavish praise on Jim, but to act as an errand boy for Winona Kirk. Didn’t Pike know that Jim was now going to discount every compliment he’d just heaped on the kid?

“Why would she be worried, sir?” Jim asked coolly.

McCoy held his breath. _Don’t say it. Please._

Pike didn’t even hesitate. “Your mother heard you’d been hurt, Jim. The ‘Fleet grapevine is nothing if not efficient.”

Jim stared at Pike, the joy and pleasure he’d gotten from the visit bleeding from every cell. “I’m… disappointed to hear that, sir. If I’d wanted her… to be informed, I’d have told her… myself.”

McCoy scowled, watching the muscles jump along Jim’s jaw. Taut cords extended along the column of his neck. The rising tension was making it more difficult for Jim to breathe. The monitor chirped a warning.

“I don’t think a call to put her mind at rest is a lot to ask, do you?” Pike said calmly.

Jim had a white-knuckled grip on the blanket as he met Pike’s stare. “That’s my business, Captain.” His blunt, matter-of-fact tone, while respectful, was a clear warning not to trespass further.

Above the bed, the monitor continued to display the steady increase in heartrate and respirations. Shit. Time to put an end to this. McCoy stepped forward. “Captain…”

“And now it’s mine. Your mother called Admiral Marcus early this morning, Jim,” Pike said, ignoring McCoy. “And Marcus called me. She even commed McCoy last night and spoke to him. Unless you want the entire Admiralty involved in this and your mother on the first transport back to Earth, I suggest you call her.”

Well, shit, that cat was out of the fucking bag.

Jim looked at McCoy with an expression of utter betrayal. McCoy cursed mentally. He took a few steps toward the bed. “Visiting hours are over.”

“I’m done,” Pike said without looking at him. “Think about it, Jim,” he said and left.

Jim was breathing rapidly and shallowly, his hands twisting in the blanket. He refused to look at McCoy, staring down at his leg instead. The monitor began to ping with warnings.

“Jim… I’m sorry,” McCoy said. “Sh—”

“What did you tell her?” he demanded, his chest rising and falling in agitation. “I didn’t give you… permission to… talk to her.”

“I didn’t say anything. I couldn’t, under the circumstances. You know that.”

Another ping.

McCoy glanced up quickly. “Jim, you need to calm down.”

Sidra hurried into the room, responding to the monitor warnings.

“Fuck this!” Jim said, furiously, tearing the nasal canula away and tossing it on the bed, “I’m leaving.”

“Jim, stop!” McCoy quickly gripped Jim’s bicep to hold him place, but Jim had already gotten his good leg out of bed and on the floor. His injured leg refused to follow and Jim, caught awkwardly between sitting and standing, trembled, his pallor alarming. “You aren’t going anywhere.”

Breathing hard, Jim pulled himself free of McCoy’s iron grasp. Gritting his teeth, he dragged his injured leg across the bed, gasping in pain but refusing to stop.

Sidra, from her position on the other side of the bed, lunged forward, catching hold of Jim’s patient gown, trying to prevent him from sliding off the bed. “Stop, Jim, please. You’re going to fall. Lie back and let us help you.”

The peripheral IV line tangled between the two of them and before McCoy could prevent it, Jim ripped the IV out with a snarl. Blood surged from the torn vein, ran down Jim’s hand and began to drip on the floor.

“Goddamn it,” McCoy said softly. He swiftly switched his grip to staunch the flow of blood with his thumb, while still trying to get control of Jim with his other hand.

“Let go!” Jim gasped, his words a near whisper as he struggled for air.

“Calm down.” McCoy could feel the tremors wracking Jim’s body as he pulled against McCoy’s embrace, struggling to escape. The monitor began to steadily ping, and McCoy looked up from Jim’s bloody arm to see that Jim was hyperventilating, his parted lips tinged with blue. “Get me 15 mg of Diazepam as soon as we get him back in bed.”

“No,” Jim protested on a thread of sound, shaking his head. He strained to move forward, open-mouthed and gasping, when he suddenly collapsed against McCoy. Only Sidra’s hold on his gown prevented him from sliding completely off the bed.

McCoy braced his knee against the bed and hoisted Jim backwards with a grunt. Sidra used his momentum to pull Jim toward the center of the bed, and between the two of them, they got Jim repositioned on the mattress.

The pinging continued, and McCoy cast a swift glance at the monitor. It was a sea of yellow and orange warning lights. Jim’s staccato breaths were labored and loud, and Sidra wasted no time getting an oxygen mask on him. Jim lay loose-boned, his eyes glassy and unfocused.

“Slow, deep breaths, Jim,” he exhorted, as the mask was securely placed around Jim’s nose and mouth. “The oxygen will help, kid. Deep breaths. Try and slow your breathing down.”

Jim’s body had failed him, but he was still fighting. McCoy could feel the tension in the muscles beneath his hands as Jim moved restlessly, the agitation brought on by the oxygen debt Jim had created with his pointless exertions. Blood continued to seep through McCoy’s fingers from the abused insertion site. He needed to get a regen unit on that. Restart another IV. Even as he planned, McCoy realized that the sound of Jim’s labored, wheezing breaths was not easing.

“Get me 20 mg of Tri-Ox and the Diazepam. Now.”

They had to get Jim stabilized. Cursing under his breath, McCoy let go of Jim’s arm. He took two steps away from the bed, and yanked open a nearby supply cart. Grabbing a pressure bandage, he hurried back. Without finesse, he secured the bandage over the torn flesh and put both of his hands on Jim’s face to steady the young man. Jim’s skin was cool and clammy. His blue eyes were bright with pain and distress, and his frantic, harsh wheezing continued, unabated.

“Listen to me, Jim. I know you’re angry because you think I betrayed your confidence, but you’re wrong.” Jim tried to shake off his hands. “You’re wrong, Jim,” he repeated. “I didn’t tell your mother anything. We’ll talk about it later, I promise, but right now I need you to concentrate on breathing, do you understand?”

McCoy knew Jim didn’t have enough air to speak, so he was stunned when Jim planted a shaking hand against McCoy’s chest and pushed, though there was little strength to it. He followed that by taking a fistful of McCoy’s scrubs in his grip, his lips twisted in anguish.

“I know,” McCoy said, gently. He could see in Jim’s eyes that the young man wanted to punch someone. All the control had been stripped away from— the Admirals were talking to his mother, Pike had yielded to the Admirals demands, his body was failing him, and McCoy was in his face, demanding that Jim listen and obey….

Sidra returned. “The Tri-Ox and the Diazepam, Doctor,” she said, holding out the hyposprays.

McCoy nodded. Both of his hands were still firmly on each side of Jim’s face, and without taking his eyes off Jim, he said, “I’m going to give you something to help you calm down. I need to get your respiratory rate under control.”

Jim tried to speak, but the words were little more than guttural groan, muffled as they were by the oxygen mask. The hand on McCoy’s chest tightened and tugged fruitlessly, and a scowl deepened the lines between Jim’s brows and around his eyes.

Sidra handed McCoy the first hypo. Keeping one hand in place cupping Jim’s cheek, he positioned the hypo against the side of Jim’s neck, only to have Jim try to arch away. McCoy shifted his hand, gripping Jim’s chin firmly, holding him still.

“Stop fighting me, Jim. The medication will help. It’s going to be all right, kid,” McCoy said and gently turned the young man’s head to expose the cardioid artery. It was the fastest way to administer the meds, faster than using the central line.

“This is going to help you. Just relax.” He felt Jim’s fingers clutch desperately at the front of his tunic. As the hypo hissed, Jim closed his eyes, still gasping for breath despite the mask. McCoy dropped the empty hypo on the bed and accepted the second one, again delivering the medication with a deft press of the hypospray into the side of Jim’s neck.

“Increase the oxygen to 100%.” Jim would get barely a third of that but short of re-intubating him, it was the best he could do.

McCoy rubbed his thumb along Jim’s cheek, keeping a firm hold on him, until he felt Jim relax. Jim eyes briefly fluttered open, his gaze dull with misery. The look in his eyes was like a kick to McCoy’s gut. Jim’s grip on his tunic relaxed as his eyes closed, and his hand fell limply to the bed.

Sidra pressed the call button and another nurse entered the room. Together they replaced the blood-soaked bed linens, then cleaned Jim up with a sonic and dressed him in a fresh gown. Sidra repositioned Jim in bed and gently arranged his injured leg on supporting pillows. The other nurse left and returned with the portable dermal regenerator.

McCoy removed the bloody pressure bandage with gentle fingers. The insertion site had stopped bleeding but the torn skin was red and angry. Sighing, McCoy affixed the regen unit to Jim’s arm and powered it on, the faint hum as it began to work nearly inaudible.

The combination of exhaustion and medication had taken the fight out of Jim, but it was a temporary victory. Jim had an eidetic memory. He remembered everything he read and heard with precision. He would remember all of this. The million-credit question was: how was he going to react going forward? Would Jim give McCoy a chance to explain? Or would he do what Jim did best, run away from the hurt of his perceived betrayal? Would Jim still want to be his friend?

McCoy studied the monitor display with sober eyes. Jim’s breathing was slowing. His heartrate had lowered, too, although he was still tachy. McCoy frowned, his heart heavy. Jim had expended precious energy in the fight and now there would be another day’s delay in his therapies.

McCoy turned to Sidra. “Get a new peripheral IV started, normal saline at 150 cc an hour. I want someone with him all the time, if I’m not in the room. Cancel his morning respiratory treatment. Notify PT that we’re done for today. Keep a close eye on his pain levels. He’s bound to have stirred up his leg with this episode.”

He grabbed Jim’s chart and began entering his new orders. By the time he’d finished, the other nurse was gone and Sidra had the new IV in place. Order had been restored, but Jim lay pale and unmoving, his wheezing breaths shallow and quick.

McCoy cursed under his breath. Winona Kirk had unwittingly unleashed a shitstorm, but it was Jim that was paying the price.

* * *

Jim opened his eyes. For a moment, he didn’t know where he was.

The gray shadows reminded him of the farmhouse. He’d often awoken to the sound of muffled sobs, as Sam cried alone in his room at the far end of the hall. Equally alone and afraid, he’d listened anxiously for the creak of floorboards, sick with fear that it would be his turn next….

Out of the corner of his eye, he caught the flash of tiny blinking lights and shifted his gaze to see the bank of medical equipment along the wall. Not the farmhouse; Starfleet Medical.

He choked back a groan. He hadn’t thought of that anxious time in years— certainly not since joining the Academy, and now a single call from his mother had stirred up all the old feelings of fear and betrayal, after he’d managed to bury them deeply inside and move on with his life. And worse, it seemed as if half the Admirals in Starfleet were going to be involved, all of them wondering why he refused to call his mother. He didn’t want to think about the look on Pike’s face; not quite condemnation but like Jim had disappointed him or something. Like Pike knew anything about what had happened to him and Sam. Where had Starfleet been then? Why couldn’t Pike mind his own fucking business?

He closed his eyes. Why had she bothered to call anyway? She’d never called all the times he’d been in the hospital as a kid, which had been plenty, thanks to her neglect and disinterest. It had been Sam who’d sat with him, looking stricken and hopeless and maybe just a little guilty. They never spoke of what had happened to anyone, never apologized to each other either, but the loaded look between them screamed all they couldn’t say… they knew.

And then she would return for a few weeks and they would pretend nothing had happened, as if they were this loving normal family that didn’t have this big secret they were trying desperately to hide, because she didn’t want to listen, didn’t want to see. As a kid, Jim had wondered if she really thought he and Sam were that accident prone and reckless. Or was it easier for her to leave if she just turned a blind eye to everything? That way, she didn’t have to think about who she was leaving them with. He’d quickly learned not to count on her. She was as absent in his life as his dead father was. It was Sam who was always there, until one day he wasn’t.

The ache behind his eyes and the throbbing in his leg drew his attention back to his body. He recalled the struggle with Bones, the suffocating feeling of not being able to get enough air into his lungs… his body weakening, everything slowing down, until his panic was suddenly covered in a gray fog of pain. How much damage had he done?

He took an assessment. The oxygen mask had been removed, but he felt the hard ridges of the nasal canula tucked under his nose and the cool brush of oxygen blowing into his nostrils. His body felt heavy, but brittle, like any movement would shatter his skin and bones, and he’d break apart into a million unrecognizable pieces. Beneath that, there was a tightness in his chest, one that kept him from taking deep breaths. So, maybe not so bad, all things considered.

He opened his eyes. The lights had been lowered, which was no indication of the time of day. They often lowered the lights to help him rest. It could be early afternoon for all he knew. He placed his right hand on his aching chest, as if that would soothe the dull heaviness that had settled there. He swallowed, trying to ease the dryness in his throat, and winced. Shit, he was thirsty. Had they left him water?

He turned his head to the left and blinked, startled.

Bones sitting motionless in the chair, which had been moved closer to his bed. At first glance, Jim thought Bones was sleeping he was so still, but he wasn’t. He was awake and watching Jim with unblinking eyes, just sitting there with his hand to his mouth, as if Jim were something to be studied… or was somehow threatening.

Jim couldn’t see Bones’ expression clearly in the dim light, so he didn’t know if Bones was pissed or just tired. He couldn’t remember Bones ever just sitting like that— silent and still, like a statue, not even a PADD in his hands. And even though Jim was awake, Bones hadn’t moved or twitched, not even to glance at the bio monitor Jim hated so much.

How long had Bones been sitting and watching him?

“You sedated me,” he said in a voice that was far weaker than he wanted.

“Yes, I did,” Bones said quietly, his tone matter-of-fact. Not the usual ranting or sarcastic response Jim had grown accustomed to hearing from his friend.

Bones’ lack of emotion made him nervous. Was his condition better or worse? He shifted his gaze to the door and saw that it was closed, with the privacy screen engaged. Definitely worse.

He could feel that the drugs were still circulating through his bloodstream, creating the heavy lassitude that seemed to weigh him down, fog his thoughts. But no longer strong enough to drag him back into immediate sleep.

He continued to gaze at Bones. The man still hadn’t moved, and his eerie stillness was all wrong. Deep in his gut, a ripple of anxiety stirred, but he couldn’t scrape enough energy together to do anything about it. It was as if he were watching all this playout outside of himself. On one level he knew he should be pissed. Bones had sedated him against his will. He wanted to demand an apology, tell Bones to go fuck himself, that he had no right. Instead he asked, “Why?”

“Because you were out of control, in danger of triggering a respiratory arrest.”

There was no anger or justification in Bones’ tone. He was just stating facts. But who made Bones Lord and Overseer? Jim could damn well do what he wanted. It was his body. His life. He swallowed again, his mouth dry. Sedation always did that to him, wrung him out like a used-up towel.

“You want some water?” Bones asked.

Jim frowned. Did Bones think it was going to be that simple? That the two of them were going to pretend nothing had happened? _Take deep breaths, Jim, one step at a time, try not to exert yourself, you’ll get there, relax, I got you._ Well fuck that. He wasn’t a kid anymore and he wasn’t going to play that game with Bones. He tried to quell his growing uneasiness over Bones’ preternatural stillness, focusing on his anger instead.

“You can’t talk to my mother.” His voice was so damn thin and faint, but even those few words had taken his breath and tightened his chest more. He stopped trying to talk, sucking in some shallow breaths, giving his lungs time to adjust. Christ, he was thirsty.

Bones sat still for a long time with an unreadable expression, then he stood and retrieved a small cup with a straw. He held it up to Jim’s lips. “Okay.”

Jim opened his mouth and Bones fed the straw in, waiting patiently while he drew in a sip or two of the tepid water. It soothed his aching throat. He wanted to down it, but even those few sips had him gasping for air. He snatched another sip, before letting go of the straw. He could hear himself panting.

“Take it slow,” Bones said softly, not making any attempt to remove the cup, just patiently waiting for Jim to catch his breath and start again.

By the time Jim had finished, he was breathless and the ache in his chest had grown to an intense burn. As Bones put the cup away, he rubbed his hand on his chest, trying to ease the pain that had settled deep within him. Bones stood in place, staring down at him, waiting patiently for Jim to speak.

“What’d you say… to her?”

McCoy looked at him, his face a mask of unreadable calm. “Not a whole lot. I told you, I can’t share your medical status with her without your permission.”

He absorbed that for a moment. “How’d she even… get hold of you? She’s in… Gamma quadrant.”

“Direct link.”

Shit. Direct link from Gamma quadrant for a non-urgent personal comm…. His mother had more pull than he’d realized. He stared at Bones. “So, you said nothing?”

“Nothing about you. She did most of the talking.”

Fuck. That was worse. “W-what… did she say?”

The first hint of emotion entered Bones’ expression. “She wanted to know if you were all right.”

He snorted and looked away. A little late for motherly concerns. Where the hell had she been when Frank was beating the hell out of him, when he was just a kid and needed her? He didn’t need her now. He didn’t need anybody. Shivering, he shifted uncomfortably in the bed, wincing as the movement pulled at his chest and leg. His damn body was disgustingly weak. Hell, even that little amount of effort seemed to use up all his strength. Why was it so difficult to breathe?

Fuck, he wasn’t going to waste what little breath he had talking to her. Fuck Pike, too. But then he remembered what Pike had said about his mother, and he turned back to Bones, worried mixing with his uneasiness. “She’s— she’s not really… coming here… is she?”

“I don’t know, Jim.”

He closed his eyes. She couldn’t come here, not now. He wouldn’t let her back into his life just because she was ready to play at being a concerned parent. That ship had sailed a long time ago. He felt his heart thudding against his chest. Everything had been fine, he’d been at the top of his class, making his own way, putting distance between himself and Iowa.

_“Maybe you like being the only genius-level repeat offender.”_

_“Maybe I love it.”_

But he hadn’t. For the first time in his life, he felt as if he belonged, as if this was what he’d been meant to do. And now his mother was going to fuck it all up. He shifted, wincing at the tightness in his chest. Why did she want to know how he was doing, anyway? Why was she pretending to care?

He heard the soft tap of Bones’ finger and opened his eyes as he felt the hot flush of medication enter through the IV. When he looked up, Bones was staring down at him, his expression sober.

Jim’s brows twitched. He wanted to rail and rant, but whatever Bones had given him was pulling him down, smothering his emotions. The anger he was clinging to leached out of him, leaving him an empty shell. He fought to keep his eyes open, as if that might help him hang on to the anger he was using for fuel.

“You can’t… talk to her.” His words were slurring. As his eyes closed, he heard the wheezing of his stressed lungs even as his heart slowed to a quiet rhythmic thump.

“I won’t talk to her, Jim. Rest now.”

The last thing he remembered before darkness took him was Bones’ hand resting gently on his head.

“Everything’s all right. Just rest.”


	6. Chapter 6

McCoy was sleeping heavily when the comm rang. He’d finished off two tumblers of Kentucky Bourbon before cutting himself off, not that it had helped much to improve his mood. Drinking alone had never been good for him, but fuck it, he’d needed a damn drink after today.

He reached for his comm. “McCoy.”

“Dr. McCoy, it’s Bailey.”

Bailey. The ICU nurse assigned to stay with Jim. As his thoughts connected the dots, McCoy came wide awake. Sitting up, he said, “What is it?”

“Kirk is spiking a fever. Temp is up to 101.5. His respirations are 38 and his O2 sat has dropped to 95%.”

 _Goddamn it._ He rolled out of bed and looked at the chronometer. 0317. He’d only left the hospital four hours ago and when he’d left, Jim had been resting quietly with only a low-grade fever showing on the monitors. His respirations had been somewhat elevated, but nothing worrisome, and McCoy had attributed the slightly higher readings to the stress of the emotional outburst he’d had earlier. “Get him on a full mask with 100% oxygen and run a full blood panel and a CBC with diff. Have the lab rush it. And I mean rush this time. I better have those results in my hand by the time I get there.”

“Yes, Doctor.”

He closed the comm. Fifteen minutes later he sailed into Jim’s room. He could hear Jim wheezing from the doorway. Bailey was in the process of tucking a cooling blanket around Jim. Jim was shivering, his hands pushing restlessly at the cold, heavy blanket, trying to dislodge it.

McCoy grabbed the chart at the end of the bed and stood looking down at Jim. His heart sank. The young man’s face was flushed with fever. The oxygen mask was securely in place, but even that didn’t completely block the sounds of his labored breathing. A turn this quickly for the worse could only be one thing. He looked down at the chart to confirm his diagnosis: pneumonia.

His mouth twisted into a grimace. “Let’s get a level 3 scan of his lungs. I want to know how far this has progressed.”

Bailey stepped back from the bed as McCoy ordered the scan. A blue light from the ceiling enveloped Jim’s chest.

“Scan complete,” the computer announced.

“Display results on monitor 2,” McCoy said, and moved to the display next to the bed. The images filled the screen and he scowled. The right lower lobe was fluid filled, with some thickening at the base which indicated a consolidation of the exudate. Bacterial pneumonia, most likely, since the thickening looked like pus rather than fluid.

Had the sedative he’d given Jim yesterday compromised his lungs? It had been risky to sedate Jim when his lungs were just beginning to heal, and he wasn’t able to fully maintain his O2 sats without supplemental oxygen. The sedation would naturally repress Jim’s ability to breathe deeply and make it more difficult for him to keep his lungs clear. And he’d cancelled Jim’s physical and respiratory therapies, both of which would have assisted in the expansion of his lungs and possibly kept a developing pneumonia at bay. But what other choice had he had with Jim combative and hyperventilating? Physically restraining Jim in bed would have only made things worse, with his emotions that wildly out of control.

 _Don’t second guess yourself, Len_ , his attending in residency had always told him. _The doubts will just multiply and you’ll drown in them._

He looked down again at the chart. Jim was going to need a strong antibiotic to fight this. Stronger than the one he’d been on days ago. The recommended antibiotic for pneumonia was Neoplycin, and Jim was allergic to it. McCoy was going to have to try another antibiotic until he had more data because Jim needed treatment now. He’d need to obtain a pulmonary specimen for c/s ASAP, in order to be sure he had Jim on the correct antibiotic. And while he waited for the lab results, he’d begin other pulmonary treatments, and hope it all would be enough to combat the pneumonia. And that Jim would prove strong enough to tolerate all of the interventions.

By mid-morning Jim’s temperature had climbed to 102 and he’d developed a wet, hacking cough. McCoy had ordered ice packs to be placed under his arm pits, on his groin and neck, to reduce the fever. Every hour they were sponge-bathing him with cool soaked cloths. His heated skin evaporated the moisture almost immediately. Through it all, Jim slept fitfully, wheezing into the mask.

Pike had had the good sense for once to stay away but he had commed McCoy for a full report, which McCoy had delivered with brisk efficiency. Neither of them mentioned Kirk’s mother.

Throughout the morning, the medical team worked diligently to bring down Jim’s fever. McCoy ordered a stronger antipyretic and increased Jim’s IV fluids to prevent dehydration from the fever. He monitored the antibiotic drip closely, on high alert for any signs of an allergic reaction.

Shortly before noon, he ordered another scan. The results showed a slight increase in the consolidation in Jim’s right lung. McCoy had been hoping for better news but reminded himself that it would take at least twenty-four hours for the new antibiotics to start having an effect. With a sigh, he reached above Jim’s head to the monitor and lowered the cooling setting on the bed by two degrees, when he felt a hand loosely grab his tunic. Startled, he looked down to find Jim staring at him with bleary eyes.

He caught Jim’s hand and bent to bring his head near Jim so that the ill man could hear. “Jim, you’re all right. You’ve got pneumonia. There’s fluid in your lungs. That’s why you’re having trouble breathing.”

Jim’s hand tightened, and he spoke in a thin frail voice that was muffled by the mask.

“Don’t talk. Everything is fine. We’re taking good care of you.”

Jim frowned. “All’ry?”

 _Allergies?_ McCoy shook his head. “No, not allergies, Jim. Pneumonia. Just some bad luck we were hoping to avoid.”

“S’kay.”

“Yes, it’s going to be okay.” He gave Jim’s hand a light squeeze.

Jim’s eyes slowly drifted shut and his hand went limp. McCoy carefully caught Jim’s lax wrist and laid his arm on the bed, alongside Jim’s torso.

The early afternoon brought more of the same. Jim’s temperature wasn’t decreasing, but it was climbing any higher, either, and McCoy was willing to call that a win. Jim’s cough, however, had gotten worse. During Jim’s coughing bouts, McCoy and the nurses would encourage Jim to cough more forcefully, but with little success. Exhausted, Jim had usually fallen back into a restless sleep as soon as he could catch his breath, wheezing into the mask, exhausted by the fight that was going on inside his body.

McCoy sat in the chair at the side of Jim’s bed, his gaze shifting between Jim and the overhead monitor. Jim lay unmoving, cheekbones painted with bright fever flags, wheezing in quick labored breaths. The oxygen flow to the mask had been increased as high as it would go, in the hope of keeping Jim’s oxygen saturation high enough to avoid intubation. Despite that, they were right on the border of needing to tube him.

A weak, wet cough drew his attention. Instantly, he was on his feet and slipping an arm beneath Jim’s shoulders to raise him up and encourage a deeper cough. “You’re okay, Jim. Cough it out. That’s right. Now take a few breaths.”

He could feel Jim’s fever through the thin fabric of the hospital gown, the hot flesh scalding against his bare arm. He tightened his hold as Jim swayed dizzily, wracked with coughing. Once the attack tapered off, Jim sagged against his chest, weak and spent. McCoy took advantage of the position and, with cupped hands, pounded on Jim’s back, concentrating on the lower lobes of Jim’s lungs.

Jim groaned and began to cough, although he managed to get his left arm between them, ineffectually trying to push McCoy away.

“I know. I know, but you gotta cough, kid,” he said. His removed Jim’s obstructing arm and continued his percussions.

Sidra entered and quickly grabbed a small basin. Slipping Jim’s mask off, she waited patiently while McCoy worked. Jim began to cough, gagging as the thick mucus McCoy had loosened filled his throat. Sidra put a hand to his nape, steadying him. “Good job, Jim. Just spit it all out. That’s the way.”

McCoy felt Jim’s muscles clench as he worked to clear his airway. Less than a minute later it was over, and he sagged, exhausted against McCoy’s arm, breathing heavily. Sidra quickly sealed the oxygen mask in place and McCoy gently eased him back onto the bed, Jim’s head lolling heavily on his arm.

With blurry, fever-dazed eyes, Jim looked at him.

McCoy smoothed Jim’s hair. “Better?”

Jim frowned and stared back at him in confusion the fever making his eyes glitter.

“We’re taking good care of you,” McCoy said, again, soothingly. “You need to rest and save your strength.”

Jim shifted restlessly, his gaze straining to focus on something over McCoy’s shoulder, as if he were looking for someone or was unsure where he was.

“You’re still in the ICU at Starfleet Medical, Jim.” He kept his hand on Jim’s head, hoping his touch would reassure his friend. “You’re sick but you’re going to be all right.”

Whether his words comforted Jim or not, he wasn’t certain. Moments later, Jim’s eyes closed in exhaustion. McCoy studied the monitor again with a scowl before turning to Sidra. Jim wasn’t responding fast enough. If they didn’t get a handle on this soon, the fever was going to suck him dry. It would be a race, then, to see what killed him first— dehydration or the chronic lack of oxygen starting a cascade of failing organs. “Let’s start a nebulizer with 2 ccs of Albutera. Repeat every two hours unless his heartrate gets above 130. Maybe that will help break this up.”

“Yes, Doctor.”

“And let’s do the pulmonary percussion therapy every two hours, immediately after the nebulizer treatments, as well.” He looked down at Jim. The young man was quickly losing strength and if they wanted to clear his lungs and keep ahead of this, they were going to have be more aggressive with his treatment while Jim could still participate. He grabbed the chart and recorded his orders before stepping away from the bed and returning to his chair to keep his vigil.

Two hours later, they roused a sleeping Jim.

“Jim, we need get some of the crap out of your lungs,” McCoy said, putting a hand to Jim’s fevered face.

Jim blinked his overly-bright eyes. “’m tired.”

“I know you are, but we have to do this. It’s the only way you’re going to get better. Right now, all you have to do is breathe in some medication. Once that’s finished, we’ll help you turn onto your side.”

It was a battle to keep Jim awake and inhaling effectively enough to make the nebulizer treatment efficacious, but finally, the medication chamber emptied.

Jim groaned in protest as they carefully turned him on his side with a thick pillow between his legs to cushion his thigh, and another tucked beneath his chest. Slightly twisted at the waist, the position allowed McCoy optimal access to the lower lobes of Jim’s lungs, where the fluid had collected.

“Sidra’s going to help you with the mucous,” McCoy said. “I want you to cough as deeply as you can, Jim.”

“I don’t… want to do… this,” he said weakly, and made a clumsy move to rise.

Sidra captured his hand and removed the mask. “It’ll be over soon, Jim. Then you can rest.”

McCoy compressed his lips tightly and nodded to Sidra. He cupped his hands and began to strike Jim’s back with rhythmic thumps, moving slowly back and forth over the lower area of Jim’s rib cage. McCoy knew the process was painful. Not because he was hitting Jim too hard, but because Jim’s fever-ridden body already ached and was extremely sensitive to touch. On top of which, the inflammation and fluid in his lungs made even the simple act of breathing painful. Having McCoy create the vibrations inside his chest to loosen the fluids exacerbated the pain.

Jim moaned and squeezed his eyes shut. His hand curled into Sidra’s. Moments later, he began to cough— weakly at first.

“That’s good, Jim,” Sidra said, waiting with the basin. “A little stronger, now. Breathe deeply and cough.”

A prolonged spasm of wracking coughs ensued, barely giving Jim enough time to catch his breath before they began again.

The coughing continued as McCoy focused his efforts on the area over the right lower lobe, the area where the scans had shown the worst of the consolidation. “Take a deep breath, Jim. The Albutera has expanded your airways. This is the best time to cough out the crap lodged down there.”

Jim made a gagging sound and coughed heavily, the sound wet and rattling. He wretched into the basin, depositing globs of thick, yellow-green phlegm. Sweat ran off his face from the effort and his body shook, but McCoy continue his cupped-hand blows on Jim’s back.

“A little more, Jim,” McCoy urged. He could hear— and feel— the thick phlegm moving inside Jim’s airway. He could also feel the tremors of exhaustion tearing through Jim’s body.

Helpless to stop the coughing McCoy’s continuing pounding elicited, Jim had no choice but to endure another round of throat-searing coughing and retching. When he finally finished spitting out the thick, gagging mucus, his head fell back onto the sheets, where he lay gasping and wheezing.

“All done, Jim. That was hard but you did great.” Sidra set the basin aside and quickly resealed the oxygen mask. She looked in the basin and nodded approvingly at McCoy.

“You did good, kid,” he said, running his hand in long strokes down Jim’s hot back.

Jim didn’t respond, his eyes closed in exhaustion, as they repositioned him to lie on his back. Within seconds he was asleep. McCoy sighed and pulled the cooling blanket back around Jim’s torso.

“How many more, you think?” Sidra asked.

McCoy glanced at her, his mouth twisted into a tight grimace. “I don’t know. Not too many I hope.”

With that, he settled back into his chair, and waited. It was going to be a fine balancing act between the aggressive pulmonary toilet and allowing Jim enough time to rest. If he got too tired to cough…. McCoy rubbed his forehead, feeling his headache intensify. 

An hour later Jim woke again, his eyes blurred and searching. “Sam?”

McCoy was up instantly, putting a hand on Jim’s arm. “Do you need something, Jim?”

“Sam,” he said again, his words hoarse.

_Who was Sam?_

“It’s Bones, Jim. You’re in the hospital. Just rest. It’s okay.”

Jim struggled to focus on him. “Don’t tell… okay?”

McCoy wasn’t sure what Jim was referring to. Don’t tell his mother that he had pneumonia? Don’t tell Pike that he was angry? Or was he caught in the labyrinth of his fevered mind, lost is a memory or dream? “I won’t, Jim. I won’t tell, I promise. Now rest.”

Jim’s eyes fluttered closed. McCoy smoothed back Jim’s hair, then let his palm rest against Jim’s hot forehead. It was a gesture Jim wouldn’t have tolerated while conscious, invariably pulling away from such a touch, leaving McCoy to wonder what had happened to Jim, that he would reject a simple gesture of comfort and consolation. And who was Sam to Jim? He’d never heard Jim mention the name before. McCoy was only now realizing how much of this man’s life was a mystery to him. He was not only Jim’s physician, but as far as he knew, his only friend at the Academy. He hadn’t fully acknowledged it before. Jim knew plenty of people, and everyone seemed to know Jim Kirk, but the kid was a loner— he went to bars alone, studied alone, took the occasional weekend off alone… It was only in the last few months that Jim had gravitated toward McCoy, spending more of his downtime with McCoy. Had Jim been lonely? Or just careful up to that point who he became close to?

McCoy’s eyebrow arched at the thought. Of course, the kid would eat broken glass before he’d admit the truth. Maybe Winona Kirk had a point; it couldn’t be easy being the son of George Kirk, the hero captain of the Kelvin, constantly feeling like you were being watched and needing to measure up.

McCoy wasn’t oblivious to the gossip on campus. Even the professors weren’t immune to the Kirk legacy, setting high expectations for Jim, who excelled at everything he did, and which, strangely, only earned him more contempt from a number of his fellow cadets. Did they think it was all smoke and mirrors? Favoritism? Maybe that’s what drew the two of them together. McCoy didn’t revere or resent Jim— he simply accepted Jim for who he was. But now McCoy was beginning to wonder who the hell that was exactly. McCoy shook his head and returned to his chair. The kid was an enigma. One he could explore more fully once Jim was back on his feet.

It was late into the evening when Jim’s fever finally began to go down. McCoy started to feel as if they’d turned a corner, that the treatments and medications together were finally having a positive effect, only to have that hope dashed at 0215 when Jim’s fever spiked without warning. The temperature sensor began to climb rapidly. 102.6… 102.9… 103... finally halting at 103.4.

The monitor shrilled its alarm as Jim’s temperature shot up into dangerous territory. Once more, McCoy lowered the temperature setting on the bio bed and then ordered the addition of a cooling blanket. Jim shivered and thrashed, fighting both Bones’ comforting touch and the nurse’s hands as she continued to bath him in cool water to drive down the fever. He moaned, occasionally mumbling an incomprehensible word or two, before grimacing and resuming his restless movements, clearly in distress.

McCoy offered words of reassurance as he repeatedly wiped Jim’s fevered arms and chest with the cooling cloths, hoping that on some level Jim heard him. He and Keri tended Jim constantly. He ordered the flow rate on both IV’s increased in order to replace the fluids the fever was burning through. When Jim was on his side, he slipped small pieces of ice between Jim’s lips, tucking the bits into Jim’s cheek, while Keri laid wet cloths on Jim’s back, replacing them when they grew too warm to be effective.

Within minutes, Jim’s exhaustion took the upper hand, reducing him to wheezing limpness. A long moment later, he opened his eyes, his gaze bright with fever.

“Why did you leave?” Jim asked weakly, staring at McCoy.

McCoy settled the cooling blanket more firmly around Jim’s lower body before he sat on the edge of the bed and squeezed Jim’s limp hand. “I didn’t leave you, Jim. I’m right here.”

Jim frowned. “You left me.”

He suddenly realized that Jim wasn’t speaking to him, that he was seeing someone other than McCoy. While he knew high fevers often resulted in hallucinations and mental confusion, it was still distressing to watch Jim experience those symptoms. McCoy placed a soothing hand to Jim’s hot forehead. “You’re not alone, Jim. I’m right here.”

“Don’t … leave. Please.”

“Okay, Jim. I won’t leave. Rest now, kid. You need to rest.”

Jim’s eyes closed.

* * *

McCoy sat uncomfortably slumped in the chair next to Jim’s bed. He’d been lost in thought when a mug of coffee appeared in front on him. He looked up to find Sidra smiling at him.

“It’s real,” she said, moving the mug so its enticing aroma filled his nose.

He took it with a grateful nod. “How’d you manage that miracle?”

“It’s better if you don’t know.” She walked to the opposite side of the bed and looked down at their sleeping patient. “I see you managed a miracle of your own. His fever finally broke.”

He took an appreciative sip of his coffee and allowed himself a moment to savor the hot brew before answering. It _was_ real. And damn good. “Yeah. A few hours ago. Antibiotics are finally kicking in.”

“He’s wiped out,” she said softly, gazing down at Jim’s motionless body. “I was beginning to think that maybe his luck had run out.”

So had McCoy. He’d worked through the night tending Jim, waking him to breathe in the Albutera and then rolling him on to his side to loosen the mucus while his airways were dilated. All their work trying to clear Jim’s lungs with the nebulizer and percussions treatments had taken the last of Jim’s strength. When the fever finally broke, Jim lay limp and unmoving in the grip of an exhausted sleep so profound that his pose mimicked death. McCoy found himself fixating on the steady sounds of the monitor, the steady beats reassuring him that Jim was still alive.

“His breathing sounds better, too,” Sidra said. Jim’s easier breaths were a welcome replacement for the labored breathing that had steadily filled the room in the past twenty-four hours.

McCoy said nothing, almost afraid to believe Jim was better. It had only been a few hours since Jim’s wheezing had dissipated, and that Jim’s low moaning and restless movements had quieted. McCoy had spent hours trying to comfort his friend, but nothing seemed to get through the pain and misery that had engulfed Jim, and his fevered mind that conjured up painful scenarios of abandonment that McCoy couldn’t help but feel responsible for causing.

Sidra looked over at McCoy. “Are we still doing percussions?”

He nodded. “Every four hours or so. He’s tolerating the Albutera well, so we’ll continue that for another day. The antibiotic seems to be working, too, because he’s not as congested. Hopefully the treatments won’t be as taxing on him.”

She did her check of IV lines, catheters, oxygen lines, before moving around the bed and straightening the linens with practiced ease. She halted in front of McCoy with her arms crossed over her chest, staring down at him.

“What?” he asked shortly, only glancing at her.

“He’s not critical, now. He’s stable. You should get some rest. We can handle this.”

“I’m sure you can.”

“But you’re not going to let us.”

He scowled, not liking the fact that she could read his intentions so easily, and definitely not liking to be told to leave. It was bad enough that Boyce was on his case. And who in the hell knew what Pike thought about this latest crisis, but the Old Man had kept quiet and stayed away, and that’s all that mattered to McCoy. That and ensuring Jim continued to breathe.

He finished his coffee, then stood and handed her the empty mug. “I want him to try and eat something when he wakes, which will hopefully be after the percussion treatment.” He checked his chronometer. That was another two hours away. Jesus, had he been at this for twenty-two hours?

Sidra nodded, and stepped aside. “What about you?”

His mouth tightened. “What about me?”

She sighed. “Will you at least take a break?”

He stood by Jim, his hand on the still-fevered face. It had been a long night and he was feeling the aches from spending so many hours in the chair. The tension in his body hadn’t let up, despite knowing that Jim was doing better. And yeah, Sidra was right, Jim was stable and out of danger, likely to sleep for hours. It’s what he should be doing. Hot shower, rest, good meal… maybe it would ease some of his guilt.

_You can’t talk to her._

One call, he thought bitterly. One goddamn call and the whole situation had gone to hell. He’d wished Winona Kirk had stayed silent in deep space instead of poking into Jim’s business when he’d obviously made his feelings clear to her. Not that he blamed her on one level. She might not have been a good mother, but she was still a mother. Still, she’d managed to damage the trust between them.

Looking down at his friend’s relaxed, sleeping face, he couldn’t erase the image of Jim’s fevered eyes frantically searching for something in the room, locking onto him and begging him not to leave. Feeling betrayed by his best— his only— friend, abandoned by his mother… Fuck. McCoy closed his eyes. He was too damn tired for this clusterfuck of a mess.

“He’s okay,” Sidra said softly from behind him. “We’ll take good care of him.”

It took him a minute to open his eyes and he realized his head was pounding. Letting his hand linger a moment longer on Jim’s still face, he pulled away and turned. “Comm me if anything changes,” he said, as he walked out the door.

And immediately run into an irate Dr. Boyce.

* * *

Two days later he walked into Jim’s room, feeling rested and focused. He’d monitored Jim’s progress, but had kept his promise to Boyce and stayed away to satisfy compliance with Boyce’s bureaucratic demands. While he hated the necessity of forcing a doctor into downtime, he couldn’t argue that he’d needed the rest. He’d slept for a solid twelve hours the first day. Once awake, he’d checked on Jim, eaten a home cooked meal— the first one he’d had in several weeks— and gone back to sleep. It wasn’t until after awakening the second time, that he’d actually gotten out of his dorm room to walk the campus and get some much-needed sun and fresh air. By 0700 this morning, he’d fulfilled his 48-hour stay of duties, and he was eager to see Jim.

Now, dressed in a short-sleeved white tunic, he stood for a moment in the doorway, observing Jim. While still clearly ill and weak, the oxygen mask had been replaced with an oxygen canula that was tucked under his nose. McCoy, who had been monitoring him remotely, already knew that his lungs were vastly improved, but it was good to see the proof with his own eyes. Since Jim still needed assistance walking for any distance due to the lingering pulmonary congestion, they’d continued with the pulmonary toilet, but not as aggressively. Despite all the treatments, or maybe because of them, Jim looked more focused and alert. He was working at stretching out his injured leg when he noticed McCoy. His thin face lit up with a welcoming smile.

“You’re looking pleased,” McCoy said as he grabbed the chart at the end of the bed, as if he hadn’t been gone for two days. “One of the nurses give you a sponge bath?”

“I wish.” Jim’s voice was still rough and weak, but his eyes gleamed brightly at McCoy’s suggestion. He stared at McCoy and seemed to be contemplating his next words. “You good?”

The question caught McCoy off guard and his brows shot up as he looked at Jim. “Shouldn’t I be asking that of you?”

Jim looked sheepish as he ducked his head, before his gaze rose to meet McCoy’s, the overhead light striking fire from the brilliant blue irises. “I mean… are we good?”

McCoy softened his expression. “We were never _not_ good, Jim.”

Silence.

“Sorry, about…” Jim shifted uncomfortably in the bed, fingers tugging restlessly on the blanket as a faint blush crept up his neck. Jim looked as if he wanted to crawl under the covers as he looked away. He struggled to speak, his throat working, until finally, he choked out, “She caught me off guard.”

McCoy nodded, opened his mouth to offer some reassuring counsel— something along the lines of no harm, no fowl, kid— when the full impact of Jim’s earlier question sank in. _Christ, he thinks I left him_. He hadn’t been sure how much of that night Jim would remember— being wrestled into the bed and sedated— and he still wasn’t sure, but obviously Jim remembered enough to be afraid that he had driven McCoy away, and was now unexpectedly contrite. He looked around the room to make sure they were alone before he spoke in a quiet tone. “You think I’m pissed, Jim?”

It took Jim a long moment before he worked up enough courage to steal a quick glance at McCoy. “I thought, maybe…”

McCoy heard his unspoken words. … _you’d left._

“Christ, kid. If I got pissed off every time a patient lashed out, I’d have stroked out by now.” Jim looked stricken— and unconvinced. “Listen, I needed to get some rest, that’s all. Boyce’s orders. He claimed I’d abused my privileges and spent too many hours at the hospital. Damn, regs.” He pursed his lips, and said dryly, “Apparently Admin frowns on the possibility of their doctors falling asleep during surgery due to inadequate rest. I had no choice about taking some downtime. But I know every medication that you’ve been given, every treatment that was administered, and what you’ve eaten. And _not_ eaten.” He paused, raising his brows. “I know you walked yesterday. Twice.”

A smile tugged at the corners of Jim’s pale mouth. “All the way to the door.”

McCoy smiled to himself. Jim looked like a little kid, half-pleased with himself for an accomplishment that was more an embarrassment than a brag. Just to keep Jim in line, to let Jim know that he was still Bones, he said in his most sardonic tone, “Don’t expect an award.”

Jim snorted softly, his smile widening ever so slightly. But Jim wasn’t looking McCoy in the eyes and that worried him. He knew enough about Jim’s body language to know that he was chewing on something, holding himself back so that he couldn’t be hurt. Jim had something he felt he should say but didn’t want to because he was afraid. Whether that was fear of rejection or anger or pity, McCoy didn’t know, and frankly, didn’t care. Dollar to donuts it was the elephant in the room, and nothing was going to be normal between the two of them, if Jim didn’t get it off his chest.

“What’s eating at you, kid?”

Jim sobered and looked away. “She caught me off guard,” he repeated. “I had no idea she’d call, even if she did hear about the… accident.”

McCoy sighed softly, hearing the reluctance and shame in Jim’s voice. Who wanted to talk about their family problems? Against his will, Jim’s dirty laundry had been aired all up and down the chain of command. He could only imagine how he’d feel if his ex-wife had called up Jim— and the Admiralty— and started unloading. “She caught me off guard, too, kid.”

McCoy hooked a toe on the leg of a nearby wheeled stool and, in one motion, pulled it close, sat down, and scooched up to the bed. Maybe now was a good time to finish the conversation they’d started days ago. Jim seemed to want to talk, so.… “I didn’t say anything to your mother about your medical situation, Jim. I couldn’t. But she already knew everything I’d reported to Pike.”

Jim chewed on his bottom lip, refusing to look at McCoy. Finally, he spoke. “Yeah,” he said quietly. “I figured.”

“I’m sorry, Jim, for— ”

Jim suddenly looked at him with an expression that was so familiar and so artfully casual, it almost made him smile. “So, Bones, when do I get out of here?”

Okay, so they weren’t going to talk about this, after all. Maybe it was the one-sided dynamics. Jim never handled feeling cornered well, and being confined to a hospital bed was the ultimate in confinement in the kid’s mind. McCoy contemplated pushing the subject a bit more, but seeing the playful and pleased look on his friend’s face, decided against it. After days of watching Jim struggling to breathe, pale and weak and terribly fragile, it was good to see a spark of the old mischievousness that always seemed to linger beneath the surface, the errant intelligence that was always one step ahead of everyone else, return. Leaning back, he regarded Jim. “A couple of days. If s—”

“A couple of days?” Jim’s expression soured. “Bones, I’ve already been here two weeks.”

“Ten days,” he corrected. “And you’re still on oxygen.”

“That’s just a technicality.”

“If you call adequate oxygenation a technicality.”

“I’m better,” Jim insisted.

“Without the supplemental oxygen, your oxygen saturation levels don’t meet the criteria for release. Right now, walking a few meters without it will cause your body to become oxygen-starved, and you’ll pass out. I don’t want to be treating you for a concussion. Again.”

“That won’t happen,” Jim said irritably. “But if you insist, I’ll take it with me.”

McCoy snorted. “Fat chance of that. I know you, Jim. You’ll get ten meters outside the hospital’s front door and ditch the oxygen.” He stared hard at Jim. “I’m not releasing you.”

“I’ll get a second opinion.”

The corner of McCoy’s mouth curled, and he locked an unflinching gaze on the man in the bed. The little shit was threatening him. This was the kid knew. “Go ahead and get one. I’m sure Boyce would be happy to do a consult.”

Jim stared back at him for a long moment, eyes narrowed. McCoy could see Jim calculating his odds and trying to figure his next, best move. McCoy remained impassive, patiently waiting for Jim to accept the inevitable.

“You worry too much, Bones. I’m fine.” Out of frustration, he kicked at the covers with his good leg, inhaling sharply. Immediately, his breath hitched, and he quickly devolved into a coughing fit. While his lungs might be improving, they weren’t fully healed. As the coughing continued, he folded into himself a little, pressing his arms to his chest as he tried to stop the wracking spasms.

Gripping the chart in one hand, McCoy got to his feet, but Jim held up his hand to stop McCoy from coming any closer. Gradually, the spate of coughing slowly subsided.

Marooned just out of reach, McCoy waited, controlling the urge to intervene. Finally satisfied it was nothing more than a residual cough from lungs that were not happy with sudden stressors, something that Jim would no doubt be dealing with over the next week, he gave the young man a condescending look and said, “You were saying?”

Jim leaned back into the bed, exhausted, and gasping. And, praise Jesus, for once he said nothing.

* * *

“Take it easy,” Sori said. “Don’t rush it.”

Rush, Jim thought sourly. Right. He was barely at a steady walk. But at least he’d made it out of his room. And he was still vertical. He’d been on his feet “walking” now for over twenty minutes and each step was getting more difficult. Sori had a firm grip on his left arm, holding him steady as he put more weight on his injured leg. The damn thing felt like he was dragging a tree limb. Despite the therapy and flexing exercises he was doing, his leg still felt stiff and cumbersome, making walking both painful and awkward.

“Keep your hip quiet,” Sori instructed. “Use your quad to lift your leg.”

Jim gritted his teeth against the fiery burn that extended from his knee to his groin and did as he was told. Sweat ran down the side of his face as he concentrated on taking each step. If he thought lifting the injured leg was bad, putting weight on it was worse. Each time his foot met the floor and took his weight, a stab of pain shot through his thigh, reaching deep into his hip. He could almost feel the path Grady’s blade had made— still tender and painful despite the surgery having happened almost two weeks ago.

“Straighten up a little more,” Sori said, gently correcting his posture with a hand to the small of his back.

Forcing himself erect, Jim paused for a moment to catch his breath. He could hear the faint wheeze as he inhaled, something that he hadn’t heard all day. Fuck, he didn’t want to go back to the mask. His chest tightened and a wave of dizziness rushed through him. He felt Sori’s hand tighten on his bicep as he swayed slightly. His vision began to blur, but he fought to stay upright. No way was he going to quit now.

“Are you okay, Jim?” Sori’s voice seemed far off. “Keep breathing. Don’t hold your breath. You’ve got to breathe or you’ll faint.”

Nodding, he took a few deep breaths through his nose, letting the cool oxygen from the canula fill his lungs. The gray fog lifted and the corridor he’d been staring at steadied. Determined, he took a step, then another.

“You’re doing great. Try a little more weight on that leg.”

He hadn’t realized that Sori had turned them and that he was headed back toward his room until he looked up and saw Bones waiting at the door, watching his progress with a very clinical expression. By the time he reached his room, his head was pounding, and his leg felt like it was on fire. It was sheer will that kept him on his feet as he shuffled toward the bed, Bones close behind.

The sound of his wheezing filled his ears and he tried to slow his breathing, but his heart was hammering like a scared rabbit. Bones caught hold of his other arm to lend support. If Bones said anything, he wasn’t able to hear it past the swooshing rush of blood and wheezing that filled his ears. Gracelessly, he collapsed onto the bed, damp with sweat.

The next thing he was aware of was a blessedly cool cloth on his face and Bones leaning in close, intensely studying him.

“Are you with me now?”

Jim blinked, “Why wouldn’t I be?” he asked breathlessly. His head hurt, but his heartrate had returned to normal and the wheezing had stopped.

“Because I’ve been speaking to you for the past five minutes and you’ve been unresponsive,” Bones said flatly.

Really? Was Bones serious?

With a grim look, Bones straightened and began to tap on the overhead panel. While he did, Jim took a quick reconnoiter of the room.

Sori was gone. It was just him and Bones. He saw that his injured leg now rested on two thick pillows and an ice pack had been placed over his thigh. A relentless burning sensation smoldered deep inside his leg. His leg felt like someone was stabbing it over and over with a red-hot knife. He didn’t think he could lift it now if he tried. Shivering, he reached for the edge of the blanket that rested near his hips, and noticed his hands were trembling.

Bones took the blanket from his hands and pulled it higher. “Give the glucose a chance to kick in. You burned through a hell of a lot of your reserves.”

He nodded and absently reached to soothe his leg, which still burned like a bitch.

“I gave you something for the pain.” Bones paused, and Jim could feel himself being studied. “You did good, kid.”

That was the hot flush he’d felt going through his IV. “Not going to break any records,” he groused, sourly.

Bones looked disapproving. “You injured the largest muscle in your body, Jim. It’s healing and getting stronger, but it’s gonna be a while before you can resume your normal activities.”

He frowned, his gut clenching. Time? “H-how much time? We’re back in session in two weeks. I’ve got Advanced Hand-to-Hand.”

“Not for another 4 weeks you don’t.” A chart appeared in Bones’ hand and he began making notes.

“I’ve got to take my second year of Advanced HTH, Bones. It’s a pre-requisite to leading a landing party.” And Pike had promised him the _Farragut_ in six months. That only gave him five months to finish a seven-month course. It was bad enough he didn’t pass maneuvers, he couldn’t afford to slow down now. “I can’t get behind.”

 _“You could graduate in four years. Have your own ship in eight.”_ Pike’s words— standard recruitment bullshit— were like waving a red flag. He’d proclaimed his own challenge. No matter what, he wasn’t backing down now.

Bones looked up from the chart with a scowl. “Jim, I’m trying to get you ready to go back to classes in two weeks. Advanced Hand-to-Hand, Combat Drills, Survival Training or anything else that requires more than you standing in one place or sitting on your ass is not high on the priority list.”

“Make it high,” he demanded. “I’ve passed all the basic training and required courses, Bones. Next year’s session is more physical.”

“I’m sorry, Jim. You’ll only be a few weeks behind. You can take the course work, but I’m not clearing you for physical activities until I’m sure your leg is up to it.”

“How in the hell do I take course work on hand-to-hand?” Bones knew nothing about higher echelon military training or the demands on a cadet in the Command Track. “I’m Command Track, Bones, not engineering.”

_You could have your own ship._

Pike’s words had haunted him the past year, goading him to excel, and he knew that the captain had kept close tabs on how he was doing, as if Jim were a personal project. He also knew there were plenty who were waiting for him to fail. His mother being one of them.

Bones looked up at the monitor, which Jim was certain was showing his agitation. But he didn’t care. He’d worked too hard to take a step back now because Bones wanted to wrap him in cotton wool.

“I want to speak to Pike,” he said, hearing the slight slur of his words. The pain meds were kicking in. He could feel himself being pulled under a numbing wave of blackness. If there was one person who could overrule Bones it was Pike. His eyes were closing. “Bones…?”

“I heard you, Jim. I’ll make the call.”

Darkness swallowed him.

When he awoke, he could still feel the lingering lethargy that was always present when he’d been given a painkiller. It took a few minutes to fully rouse and recognize his surroundings, and once he did, he realized that he wasn’t alone. Pike was standing next to his bed wearing an amused expression.

“Welcome back,” Pike said. “McCoy informed me that you wanted to speak with me.”

Jim pushed a hand through his matted hair and caught a whiff of body odor. Not exactly how he wanted to be having this conversation with the captain. Then again, Pike had seen him looking worse. Much worse. He looked at the captain and noticed Pike was in civilian wear. “You’re not in uniform?” His voice was rough.

Pike grinned. “Even captains get a day off. What did you want to speak to me about, Jim?”

Jim looked around for some water. The oxygen always made his throat dry, and the painkiller Bones had administered hadn’t helped. Pike seemed to interpret his need and reached out to retrieve the glass of water from the small lap table. He handed it to Jim without a word and waited patiently as Jim drank. When Jim finished, he set the glass back and regarded Pike, trying not to look like the disheveled and frail kid he felt like. “I didn’t mean to interrupt your day off, sir. This could have waited.”

“Don’t worry about it. You haven’t exactly been able to keep office hours.” Pike tilted his head as he stared down at Jim. “McCoy tells me you’ll be discharged in another two days. You must be relieved.”

Jim tried to sit up straighter in the bed, but his elevated leg made the effort futile, so he settled for squaring his shoulders and hoping that the movement adequately communicated his seriousness. “That’s what I wanted to talk to you about, sir. McCoy won’t release me for hand-to-hand for a few more weeks. I’ll get behind.”

Pike’s eyebrows rose. “Behind? Last I checked you were a good six months ahead of schedule to graduate.”

“I’m graduating in three years, sir,” Jim corrected.

“Okay. So, your timeline is four months behind. What does hand-to-hand have to do with this? There’s plenty of course work to complete, including navigation and warp calculations. I can work with your instructors on rearranging the order of some of your studies which would give you more time to heal before Combat and Advance HTH.”

“ _Farragut_ ships out in six months, sir.”

“Ah. You think this will jeopardizes your spot?” Pike shook his head. “Advance HTH and Survival are desired, not required. You won the spot based on your academics and ability to produce results, Jim. Not your fighting skills. Unless you get put on academic suspension or receive some other demerit, you won’t lose your place on the _Farragut_.”

Jim digested Pike’s words. “Survival training is essential for joining and leading a landing party, sir. Without it, I won’t be able to perform those duties.”

“Something tells me your survival skills will be just fine. I’ll be sure Captain Garrovick is so informed when you join the _Farragut_.”

“I can handle hand-to-hand, sir. McCoy’s being cautious. You could order him to release me. Regulation 17. 025 states th—”

“I know the regulations, cadet.” Pike’s tone was stern.

“Then you know you can order McCoy to release me to full duty.”

“I can, but I won’t.” Pike nodded to Jim. “Focus on resting and recovering. And listen to your doctor. When you become captain, you’ll always be balancing your duty and your limits. It’s the CMO’s job to help with that balance. They will be times when you’ll be forced to slow down or stand down, and you have to learn to accept that. A dead or incapacitated captain is no good to anyone.”

Neither was a hamstrung one, but he didn’t say that to Pike.

“Have you spoken to your mother?” Pike asked.

Jim bristled. He’d thought he’d already settled that issue. “That’s a family situation, sir.”

“Fair enough. But you’re coming up on your second psych eval for command. This one goes deeper than just the routine assessment for general mental fitness. It’ll probe your _family situation_. Especially yours, given your last name.” Pike paused. “That eval could take your spot on the _Farragut_ , Jim. Whatever issues you have with your mother, I suggest you resolve them.”

After Pike left, Jim stewed. That hadn’t gone at all the way he wanted.


	7. Chapter 7

McCoy finished cleaning the kitchen and took a moment to rest his hips against the counter. He was aware that he was lingering unnecessarily in the room, but then he was a master at procrastination when it came to interpersonal issues. His apartment— if you could call it that— was small, equipped with only the bare essentials. Fine for just his needs, but with an unexpected guest, the cramped Academy-issue dorm room made it impossible to find private personal space, which he desperately needed. He’d released Jim from the hospital two days earlier with the stipulation that Jim stay with him for a week. Now those two days felt like two years.

_“I don’t need a damn babysitter, Bones. I’ll be fine.” Dressed in civvies and leaning heavily on the edge of the bed, Jim stared at him with stubborn blue eyes, his jaw set._

_McCoy stared right back, crossing his arms over his chest. “It wasn’t a suggestion, Jim. It’s my place or you stay here.”_

The ultimatum hadn’t gone over well, but Jim was hardly in a position to argue. The rest of the cadets were still on break, Jim’s former dorm was closed and empty, and McCoy insisted on supervision of some kind, after the rollercoaster ride of Jim’s hospital stay. 

Jim was the worse evaluator of his own health. There was no way on god’s green Earth McCoy was going to trust the kid to reach out and ask for help if things went south. Jim was still recovering. He was weak, tired easily, and his leg was still unstable when stressed. In addition, McCoy was continuing to perform percussion therapy twice a day in order to clear Jim’s lingering cough. They had just finished the morning session, which had set off Jim’s irritable mood.

_“Cough it out, Jim.” McCoy kept the continuous clapping going on Jim’s back._

_Face down on the couch with a pillow stuffed under his chest, Jim’s hands were locked in a white-knuckled grip on the cushions. His eyes were squeezed tight against the pain the percussions caused, but he was helpless to stop the coughing and expelling that followed in the wake of McCoy’s rhythmic pounding. When it was done, he opened a weary eye. “I thought I wouldn’t need this anymore, once I got off the oxygen.”_

_McCoy kept a comforting hand on Jim’s back. “When you don’t spend half the night coughing instead of sleeping, we can stop.”_

McCoy rubbed his eyes, recalling the sullen mood that had followed on the heels of the percussion therapy session. Jim had been moody and withdrawn for the remainder of the morning, choosing to bury his nose in a book— an honest-to-god paper book— from his personal belongings, instead of talking. McCoy had left him alone, knowing that a poor night’s sleep was responsible for a great deal of Jim’s irritability.

When lunchtime approached, Jim responded to McCoy’s inquiries about what sounded good by declaring he wasn’t hungry. Rather than arguing with him, McCoy decided to entertain Jim, and hopefully pique his appetite, by showing off his culinary skills. The ploy had worked, and instead of refusing to eat, Jim had carefully perched on the stool at the miniscule counter and watched McCoy assemble a simple lunch, eventually intrigued enough to engage in civilized conversation for the first time in two days.

With a sigh, McCoy exited the kitchen. Despite the silence, he knew Jim hadn’t gone far. As he entered the living area, his gaze fell on the figure on the couch. He was pleased to see Jim curled on his side, fast asleep. At last. Picking up a nearby throw, he carefully covered Jim, then made his way to the small desk flanking the wall. With a quiet keystroke, he clicked the terminal on, and requested his messages. Next year’s Academy schedule had been posted yesterday and he hadn’t had a chance to review it yet.

An hour later, he sat back. Year two of the curriculum looked far more interesting than his first year. The focus would be on non-human anatomy and physiology, field medicine, and space-related stress factors. Those classes, along with a healthy hospital surgical schedule and the required medical research project, would keep him busy. Busy enough, he hoped, to forget about Atlanta and his former life, a life he’d had no choice but to leave behind.

Occasionally, against his better intentions, he wondered what he’d be doing if Jocelyn hadn’t made it impossible for him to stay, if he hadn’t joined Starfleet. Sitting in his tiny dorm room on the San Francisco campus was a world away from his past as a respected, top-notch surgeon at Atlanta General. Not only had he had a thriving and satisfying career at one of the best trauma hospitals in the country, but he had enjoyed living in a luxury condo that overlooked the lush, green park, a very visible sign of his professional success. Jocelyn was enjoying that condo now, along with every penny he’d earned to pay for it and the other trappings of their affluence.

He was staring at the screen, contemplating the intelligence of his decision-making choices when a new icon on the bottom of his screen caught his attention. Frowning, he leaned forward and touched the icon. It was Jim’s personal comm. Someone— Pike most likely— had transferred it to his terminal. Not surprisingly, the comm access screen was locked. McCoy frowned. Pike wasn’t taking any chances with Jim’s privacy, not that McCoy would have pried. He knew better, even if Pike didn’t. Jim guarded his personal life like an armed guard at the Federation treasury.

Transferring Jim’s comm was certainly an interesting move, strategy-wise, on Pike’s part. Aside from ensuring that Jim would be able to review his evaluations from his instructors and next year’s schedule, there were also likely to be personal comms to be read. And not just from his fellow classmates and pining bedmates.

_“I wouldn’t be waking you up in the middle of the night if my son would take my comms, Doctor.”_

Shit. Was this another one of Pike’s moves to get Jim and his mother to talk?

He stared at the icon, a sinking feeling settling into his gut. As if Jim’s mood wasn’t bad enough already.

* * *

Jim felt sluggish and thick-headed as he awoke. It took him a moment or two to shed enough of the sleep-fog to realize where he was.

The smells were his first clue that he wasn’t in the hospital. He’d grown accustomed to waking in the hospital to the sharp, dry tang of disinfected, sterile air. A warm current of air, carrying scents of sunshine and lemon and vanilla, caressed his cheek, causing him to blink. Nothing had smelled this good in the hospital.

And then, a switch flipped, and he remembered: Bones. He had stretched out on the sofa after lunch, intending to just rest his eyes while Bones cleaned up the kitchenette. He must have fallen asleep. Shit. And Bones had put a blanket over him like he was a goddamn baby that needed to be tucked in.

Jim clumsily untangled himself from the blanket and swung his feet to the floor. He yawned, feeling half-awake as he ran a hand through his rumpled hair, then rested his heavy head in both hands as he tried to chase the sleep from his torpid brain. A weak coughed followed on the heels of his yawn and his shoulders shook as a spasm of coughing ensued. It was long minutes before he raised his head. McCoy sat in the chair opposite the couch, head down, studying the PADD in his hand.

“How lo—” The words caught, rough-edged, in his dry throat and he coughed again to clear it, feeling the sharp pull in his chest and ribs. “How long have I been asleep?”

McCoy glanced up at him over the PADD. “About three hours.”

Three hours. He looked through the narrow windows, both of which were open to the warm, afternoon air, at the lowering sun. “You should’ve woken me.” He tossed the blanket aside in irritation and stood, swaying slightly before regaining his balance.

“Why? You got somewhere to go?”

He threw McCoy an annoyed look. McCoy knew damn well he didn’t. “How am I supposed to get better if I sleep all day?”

McCoy set his PADD on his lap and focused on Jim. “That’s _how_ you get better, genius. Your body needs rest and food to heal. Speaking of which, I made a lemon pound cake while you were sleeping. It’s my grandmother’s recipe. How about a slice and a glass of milk to tide you over until dinner?”

Jim ignored him. Walking, or rather limping, he made his way to the bathroom. Sleeping all day wasn’t going to build up his strength or get his leg back into shape. He needed to be ready for the rigors of hand-to-hand and Survival Training, and whatever else was next on his schedule. If something as simple as staying awake for four hours tired him, he’d never pass those courses in his present condition.

After emptying his bladder, he stood over the sink and took the opportunity to clean up a little. Studying his thin face in the mirror, he cringed. Christ, he looked pale. Faint bruises marred the skin under his eyes, and he looked drawn and frail, like he had one foot in the grave.

_No wonder Bones is worried._

His leg started to throb, and he shifted his weight to his good leg. He took a deep breath, which made him cough again, and he tried to muffle the sound of the spasm against his forearm. The pulmonary treatments were brutal, even if they did make it easier to breathe, and he wanted to avoid any more of them. If Bones heard him coughing… When he finally regained control, he rubbed his hands over his face in an attempt to banish some of his pallor, and headed to the kitchen, hoping a glass of cool water would help his cough.

He stared at the golden loaf on the cooling rack next to the sink, lost in thought. Why the hell was he so tired all the time? Why wasn’t he hungry? He knew he’d lost weight from the way his pants gaped at his waist above sharp hipbones. And the jutting cheekbones he’d just seen in the bathroom mirror were an even more visible sign of his lack of fitness. _Fuck. Could he be anymore pathetic?_

He finished the glass of water, and turned, still deeply sunk in his dark thoughts, only to be startled by McCoy’s looming presence. His friend was standing by the counter at the entrance to the tiny kitchen, watching him with an impassive gaze.

“What?”

McCoy shook his head, crossing his arms over his chest. “I’m just impressed your hydrating without me having to hold you down and pour it down your throat.”

Jim snorted and walked past McCoy. “That hardly sounds like an approved medical treatment. Anyway, you don’t have to monitor me every second. I can take care of myself.”

“Right,” McCoy drawled sarcastically.

Jim huffed out a breath and hesitated when he entered the living room, despite the ache in his leg. Disgruntled with the situation on every level, he walked over to the desk and the terminal, instead of reclaiming his spot on the sofa.

“What do you think you’re doing?” McCoy asked, a wary look in his eyes.

“Pike said he’d arrange to have my comm forwarded here,” Jim said, pointing to the desk. “I’m going to check my schedule for next semester.”

McCoy stepped toward him, lips pursued. “How about some fresh air instead?”

Jim turned and eyed McCoy suspiciously. “Seriously? You’re going to let me go outside? Aren’t you afraid I’ll catch a cold or stub my toe?”

“You already have pneumonia,” McCoy said impassively. “And you’re not going out alone, so I’ll catch you if you stub your toe, and start to fall.” He eyed Jim. “C’mon, Jim, a little warm air and sunshine would do you a world of good.”

Jim considered the offer. Fresh air and walk outside sounded better than good. It sounded like heaven. His comms could wait.

* * *

McCoy woke to the low guttural moans of distress.

Sleeping flat on his back on his side of the bed, he blinked as the sounds penetrated his slowly waking brain. Another soft, stuttering groan brought him fully awake, and he turned toward Jim, who was asleep next to him.

The young man lay curled on his side, covered in sweat and breathing rapidly, his limbs jerking in response to his dream. Raising up on an elbow, McCoy deliberated whether or not to wake Jim. The kid had nearly fallen asleep over his plate, completely exhausted by their walk. After barely eating any of his dinner, McCoy had rousted Jim from the couch and half-carried him to bed. Jim had fallen into a deep sleep almost before he was horizontal, not even twitching when McCoy had undressed him enough to sleep comfortably.

The thought of disturbing that well-earned and needed slumber, no matter how troubled it seemed, caused McCoy to pause with his hand hovering over Jim’s shoulder. He didn’t have to deliberate for long. Jim suddenly stilled and fell silent. His breathing slowed, and the muscles in his face softened into the serene expression of peaceful sleep. Within moments, Jim was once again deeply and peacefully sleeping. Relieved, McCoy lowered himself carefully onto the mattress, and closed his eyes, falling back to sleep between one breath and the next.

He didn’t know how long he’d slept when a blow to his jaw woke him with a jarring force. The numb ache in jaw barely registered when he heard Jim.

“No! Sam!” Jim jerked, flinching, his elbow striking McCoy’s shoulder this time.

McCoy jackknifed awake in bed, instantly alert, his heart pounding. He stared down at the man next to him, trying to get a clear look at Jim’s face in the dimly lit room, as he thrashed.

“Sam!” The desperate call sounded as if it was torn from the depths of Jim’s soul, and it was immediately followed by a short, wracking sob.

_Shit._

“Jim.” This time McCoy didn’t hesitate. “Lights 25%,” he ordered and firmly shook Jim’s shoulder, alarmed by the feel of the wet, sweat-soaked shirt beneath his palm. “Wake up, Jim.”

“Don’t,” Jim begged, his face contorted into an expression of agony.

McCoy shook his shoulder again, intent on waking the man, when Jim suddenly sat up, arms flailing wildly. McCoy instinctively wrapped his arms around Jim to both comfort and contain. “It’s all right, kid. Everything’s okay. It’s just a dream.”

“Stop!” Jim shouted, struggling against McCoy’s hold.

“Jim. Wake up! You’re having a dream. You’re safe, Jim.” McCoy lips were close to Jim’s ear as he spoke soothingly. He kept his arms locked around the younger man, trying to keep both himself and Jim from getting hurt as Jim struggled to escape whatever terror drove him, Jim’s muscles rock-hard with tension. He continued to resist, trying to break McCoy’s iron grip, and McCoy could hear him gasping for breath. “Jim! Wake up, kid. Everything’s okay. It’s just a nightmare.” He pressed his chin to the top of Jim’s head, offering comfort in any way he could. “You’re safe, I promise. I’ve got you.”

Emitting a sharp cry of anguish, Jim suddenly stopped struggling and opened dazed eyes. Gasping and shaking, he began to cough weakly, leaning into McCoy’s embrace. He still seemed half asleep, his face contorted, as if the remnants of the dream still had a grip on him.

“Jim, are you okay?” McCoy asked quietly, watching Jim’s face for signs of returning awareness. “You awake now?”

It took a long moment, before Jim nodded numbly. He tried to push away from McCoy’s embrace, but his effort was weak, and his arms trembled. Cautiously, McCoy loosened his embrace and dropped his arms, freeing Jim. The young man didn’t move, his limbs limp and unmoving, like a puppet whose strings had been cut. There was a look of confusion on his pale face.

“You all right?” McCoy asked, eyeing him closely in the dim lighting, trying to determine if Jim was fully awake and aware.

Jim’s shirt was wet with sweat and clinging to him like a second skin. He nodded once, shivering. He looked gutted, obviously still trapped in the emotions of the nightmare.

McCoy pressed his hand to Jim’s back, feeling the tremors wracking the kid’s body. Christ, he was shivering like a newborn pup, and clearly in shock. But more worrying, Jim still hadn’t said a word since awakening. “Jim, talk to me.”

Jim’s breathing had finally slowed to something approaching normal. He fell back onto the bed, turning on his side, his shoulders curled, and his spine curved. McCoy was familiar with that body language. It was Jim’s way of saying ‘Fuck off and leave me alone.’ A short coughing fit followed the change in position, leaving Jim grimacing in distress. With eyes half-closed and unfocused, McCoy wondered at Jim’s level of awareness.

“Jim?”

“What?” he asked numbly.

“Do you know where you are?”

Jim didn’t look his way. When he spoke, his voice was flat and low. “Not in Iowa.”

“No, not in Iowa.” McCoy slipped a hand under the soaked tee and rubbed his back, mostly to ground Jim, but also to warm him. Jim’s skin felt like ice. “You’re gonna catch a chill in those wet things. You need to change.”

Jim shrugged off his hand and pushed the covers away. Awkwardly swing his legs out of bed, he pushed up from the mattress with a grunting wheeze, then stood, swaying.

McCoy scrambled off the bed, hurrying to reach him. Before he could grab Jim’s arm, Jim staggered forward, evading his touch, heading toward the bathroom. A moment later, the door slid shut.

McCoy remained frozen in place next to the bed, letting his own accelerated heartrate slow. Jesus. He’d never seen such a powerful reaction to a nightmare. Night terror was more likely. Jim’s entire body had been vibrating and it’d taken the kid a while to wake up, as if the nightmare still clung to him with foul and sticky fingers. And who in the hell was Sam? Jim had asked for Sam in the hospital when he was delirious with fever. McCoy had reviewed Jim’s personnel file and could find no reference to a Sam. Jim had never once mentioned that name to McCoy in the time he’d known Jim. Whoever Sam was, Jim held strong emotions for him.

Releasing a pent-up breath, McCoy considered his next move, not quite sure what to do, but knowing that he couldn’t afford to appear unduly disturbed by what had just happened. He was Jim’s doctor, for Christ’s sake. When he heard the shower turn on in the bathroom, he sighed and rubbed his jaw, the stubble rasping in the silence of the room. The disheveled bed caught his eye. A freshly-made bed was something he _could_ do for Jim, and he quickly took the opportunity to change the sheets.

He’d just finished when Jim emerged from the bathroom looking no better than when he’d entered— pale and shaken and utterly wrecked. He caught McCoy’s gaze for a brief moment, his expression closed and remote. His gaze shifted to the bed and his mouth tightened. In an instant, he pivoted, limping out of the bedroom.

With a heavy sigh, McCoy followed. When he entered the living area, he saw Jim sitting on the couch, staring out the window. The living area lights had turned on in response to the movement, the brightness highlighting Jim’s pallor, and the lines of pain bracketing his mouth and eyes.

“Lights, twenty percent,” McCoy said quietly, ordering them down.

It was 0325 and the campus was still dark. Only the steady glow of the lampposts along the sidewalks of the common and the regular, red blink of the antennae on top of the Daystrom Building were any indication that life might exist outside this room.

McCoy halted a few meters from Jim. He fought the urge to pick up the blanket and cover Jim, who was still shaking slightly, but knew instinctively that the offer would be rejected. The kid really should go back to sleep. He needed it. But what kind of an asshole would tell a man who just woke from a nightmare to go back to sleep?

Feeling his own fatigue pulling at his limbs, McCoy eyed his options. The couch was inviting but sitting next to Jim seemed too close for the moment. Jim needed his space, or he wouldn’t have come into the living area to sit in the dark. But he wasn’t going to leave either. He turned toward the only other chair in the room and sat down.

Jim continued to stare out the window, his face a study of regret. Even in the lowered light, McCoy could see that Jim’s body was tightly wound and trembling, as if there was a fine current running through it, his jaw tense and lips clamped. Jim’s expression was taut with dread and a weariness that looked too heavy to bear, like a prisoner condemned to a life sentence. Or maybe it was just a bad memory, like the one that had induced the nightmare, recycling yet again, a reminder of something long past and better forgotten. It was eerily similar to the expression Jim had worn when he’d been told his mother had reached out.

_Come on, kid, talk to me._

But Jim remained silent and still, staring out the window as if the night world held all his answers. What could McCoy say to comfort him? He didn’t even know what the nightmare had been about or even what had caused it, and clearly Jim wasn’t offering any clues. There were times when Jim wanted comfort. Even sought it out. And there were other times, grim, harrowing times, when Jim closed himself off from any word or touch of support or caring and withdrew into some dark place that McCoy couldn’t enter. Usually, Jim was drunk when that happened, and McCoy knew better than to press at those times. This was the first time he’d seen that look on Jim’s face while sober.

_Stop trying to fix everything, Len,” Jocelyn snapped. “Can’t you just fucking leave something alone?”_

Sound advice.

He was a doctor. He’d been trained to save lives. Assess, diagnose and treat. It was difficult to turn that part of his brain off, as his ex-wife would attest. But if he’d learned one thing from his divorce, it was that people didn’t always want to be helped on his timetable.

With resignation, McCoy settled into the chair to keep Jim company. To offer the thin comfort of his presence. The slow minutes ticked past in silence, and he watched the windowpane gradually lighten as daybreak approached. Gray light filled the room and he watched the Academy lights fade.

It was just after dawn when Jim finally fell asleep, his body lax, his head resting against the worn back of the couch. McCoy gently coaxed him vertical, taking care to support his leg. He covered him with a blanket, observing him closely, as he tucked the blanket around his body. In sleep, Jim looked so damn young. Too young to be carrying whatever burdens haunted and woke him in the middle of the night. McCoy gently rested a hand on the side of Jim’s face, wishing he could take away whatever demons that chased him.

It didn’t take a trained psychiatrist to see that Winona Kirk, Pike, even this Sam that Jim cried out for in his dreams, had all failed to be there for Jim when he needed them, like so many others in Jim’s short life.

McCoy didn’t intend to join that list.

But that was a fine line between giving Jim what he wanted and giving Jim what he needed.

* * *

With one ankle resting on his knee and one hand holding a tumbler of bourbon, McCoy relaxed back into the cushioned armchair, silently watching Jim as he sipped the smooth whiskey. The kid reminded him of a tiger in a too-small cage.

Jim paced back and forth in the narrow floor space along the wall. Earlier he’d restlessly walked the length of the entire room, navigating around furniture and making laps from one end to the other. After innumerable circuits, he’d limited himself to the uncluttered five-meter aisle connecting the living room to the kitchenette— pacing back and forth, back and forth, like a trapped and desperate animal looking for escape.

McCoy was waiting him out. He knew better than to try and force a conversation with Jim while he was still this agitated. Eventually, Jim would exhaust himself and then they could talk about the comm that had sent Jim into this tailspin after reading it.

McCoy took a sip of the bourbon, letting the liquor rest on his tongue before it slid a harsh, fiery path down his throat. It wasn’t the good stuff. He kept that bottle hidden away for special occasions. This was the company bourbon, the kind you didn’t mind sharing, and it was good enough to suit his current purposes. He balanced the tumbler in his hand on the arm of the chair as he studied Jim. The kid’s limp was getting more pronounced, but he wasn’t showing any signs of slowing down.

Stubborn. He’d known Jim was tenacious. He’d seen the kid focus on a single problem to the exclusion of all else, chewing on it and chewing on it, until he was satisfied that he’d solved it correctly. And given Jim’s academic aptitudes, that process usually didn’t take him very long. This wasn’t an academic problem, however, and Jim didn’t know how to solve it to his satisfaction. Pike had pitched an emotional hot potato into Jim’s lap, not a logistical one with a neat solution conveniently available.

And the one thing he’d observed about Jim Kirk in the past year was that he didn’t do emotion well. He was a pro at deflection, though. Probably had a lifetime of experience with it. But this was something he couldn’t deflect, and that was why he was pacing, trying to escape the inescapable. But who was McCoy to throw stones? He’d escaped to Starfleet for the same damn reason: to get away from his life. Only Jim couldn’t get away from this situation. Winona had made sure of that.

Finally, Jim stopped and leaned a hand against the wall for support, looking exhausted. He shifted his weight to his good leg and stood unmoving, tight-lipped and breathing heavily, his shoulders bowed. His head hung down, as if the weight of it was too heavy to support. Jim seemed frozen in place, a perfect depiction of dejected defeat. McCoy grew concerned as the minutes crawled by, but he forced himself to remain silent. He watched Jim’s breathing slow, observed the fleeting expressions of pain that crossed Jim’s face when he shifted, forcing himself to give Jim time to regroup, and gather the strength to straighten.

Jim seemed to be contemplating his next move. He ignored McCoy as he rested, chewing on his lip, a determined look slowly growing on his face. At long last, he raised his free hand to his face and rubbed his eyes, as if he were scrubbing away the sting of unpleasant images. Then, slowly shifting his weight, he pushed away from the wall and hobbled his way to the couch. He flinched as he sat down. Cradling the trembling limb in his hands, Jim carefully lifted his leg up and onto the cushions, grimacing as he stretched it out. He leaned back against the arm of the sofa with a long-suffering sigh, tipping his head back and staring up at the ceiling.

More long moments passed. McCoy sipped his bourbon and waited. At least Jim was sitting now, and he didn’t have to worry about the man collapsing and re-injuring his healing leg. He watched Jim carefully. Slowly color returned to his face, and his breathing eased, but Jim’s expression remained closed. Finally, Jim spoke.

“She wants to see me,” he said quietly.

McCoy’s stomach tightened. So, his gut instincts had been right, he thought bitterly. Winona Kirk had used Pike to do an end run and leave a message for her son. Nothing like grand gestures to grab your attention. Jim wouldn’t take her comms, but the woman thought that maybe he’d like a _visit_? Jesus. He wondered how many messages of hers Jim had read through, and deleted, before Winona had become frustrated enough to make that request?

His limited exposure to the Commander had created a picture of a determined, but not emotionally wounded woman. Was this her final attempt to reach out and begin to repair the damage that she had done over Jim’s lifetime or, ignoring everything that had come before, was it just the simple and predictable desire of a mother to see her injured son?

McCoy chose his words carefully. “Not an unusual request. From a mother.”

Jim snorted. “I wouldn’t exactly call her that.”

Wrong words. Jim’s bitter condemnation made McCoy wince. He had to wonder what the hell the woman had done— or not done— to deserve such criticism. Jim was not, by nature, a vindictive man. Stubborn, absolutely. Conceited, arrogant, self-assured, but not revengeful. If anything, he seemed to understand, and forgive, people’s foibles. He had a genuinely generous heart. This breach with his mother had been caused by more than a single incident or a few forgotten birthdays. McCoy’s gut was telling him that something deeper and darker had driven a wedge between them.

“What do you want to do, Jim?”

The muscles of Jim’s jaw bunched, and his hands curled into tight fists. Suddenly, he sat up, one leg on the floor, clenching his fists and staring down defensively at the dull gray carpet. “I don’t want to see her.”

The emotional confession sounded like it had been ripped from the depths of Jim’s misery.

“Then don’t,” McCoy said calmly, watching Jim closely.

Jim closed his eyes, his expression pinched. Shoulders bunched with tension, he looked ready to tear something apart. “It’s not that easy. She’s contacted every goddamn Admiral in the Fleet.”

Politics, McCoy thought bitterly. “Jim, nobody’s going to hold it against you if take a pass on this request. Write your mother a nice note to reassure her you’re not dying and move on.”

Jim’s head snapped up and he pinned McCoy with an angry stare. “I can’t just write her a note, Bones! Pike says if I don’t fix this, I might fail my next psych eval. If I did, that would wash me out of the Command track and I can’t let that happen.”

McCoy wanted to curse. The captain should have known better than to put that kind of pressure on Jim while he was ill. “I can’t believe less than perfect family dynamics is the issue. Not everyone in Starfleet has a great family situation.”

“Not everyone has the last name of Kirk,” Jim said bitterly.

Fair enough.

“I can see where that complicates things,” he said evenly. “But it’s not a deal-breaker. There’s a compromise here, Jim. She wants you to throw her a bone.”

Jim shook his head, breathing hard, repudiating McCoy’s attempt to defuse his frustration and anger. “I’m not going to meet with her! I’m not going to talk to her! She doesn’t get to just walk back into my life!”

The tirade produced a coughing fit that brought tears to Jim’s eyes. McCoy jumped to his feet, and when Jim waved him away, went to the kitchen and retrieved a glass of water. Returning, McCoy waited until the fit of coughing faded, then offered Jim the glass.

“Drink that,” he said quietly, and sat down next to Jim on the couch. He waited until Jim had drained the glass, and a measure of calm had been restored before he spoke again. “I don’t know what happened between you and your mother, Jim, what she did or failed to do— and you don’t have to tell me anything— but it’s clear you can’t keep your relationship with her the way it was.”

“Why not?” Jim asked faintly, not looking at him.

“Because the genie’s out of the bottle, kid. She’s got the Admirals in a tizzy, Pike’s tit is in the wringer, as a result, and you’re caught between a rock and hard place. It’s not fair to you, because she’s the one who’s caused all this ruckus, but you’re gonna have to figure something out. And I’ll help you, in any way I can.”

“You can’t help me,” Jim said miserably.

Which was such a youthful thing to say, he thought with amusement, as if this were a unique situation with no possible solutions. He tipped his head slightly. “I have a mother, too, you know.”

Jim spared a glance at him and he could see that Jim was considering his words. Biting his lip and looking like the whole damn weight of the world rested on him, Jim scowled and turned away.

_Come on, kid, ask for some help._

Tense silence filled the room. When Jim showed no signs of shifting from his emotionally entrenched position, McCoy decided to switch tactics. “Who’s Sam?”

The blood drained from Jim’s face.

For an anxious moment, McCoy thought Jim was going to faint. He put a hand on Jim’s arm as the man swayed and he quickly got to his feet. “Lie back, Jim,” he commanded calmly, and used the hand on Jim’s arm to lower him to lie flat on the couch. But Jim resisted, pushing McCoy away as he tried to steady his breathing.

“Jim-”

“I don’t want to talk about Sam.” Jim’s mouth tightened, and a deep frown had settled above his eyes.

McCoy nodded, studying him carefully. “Okay,” he said quietly.

With that settled, Jim released a weary sigh and leaned forward. “How do I compromise with my mother?”

Nice deflection, McCoy thought, returning to his armchair. Just like a pro. Sam was a forbidden subject, but at least he’d gotten Jim to talk about his mother without shouting or turning a cold, deaf shoulder. That was progress.

“How do you want to compromise?”

Jim pinned him with an irritated glare.

“I don’t know anything about the situation between you and your mother, Jim. It’s difficult for me to advise you when I’m in the dark.”

Jim looked away, frowning. His shoulders drooped. After another long minute, Jim said, “She was never around. Never.”

“Isn’t that the usual outcome when Starfleet personnel serve on starships?”

“She didn’t have to serve on a starship, Bones. She could’ve been assigned planet-side. She was the wife of a hero. She could’ve written her own pass.”

True. That meant she chose assignments that took her far from Earth. And Jim. He could hear Winona’s words, _“I wasn’t always there for him … Things… happened… that shouldn’t have.”_

“That must have been difficult,” he said. He understood now why Jim was so fiercely independent and reluctant to accept help. By all accounts, he’d raised himself. Or had he? “Who took care of you?”

Jim let out a short breath. “An asshole.”

Jesus. Now he was beginning to see, and his heart ached. “I take it your mother wasn’t aware,” he asked cautiously.

“How could she be? She was never around. Never. And the few times when she was—” Jim’s fingers curled into fists and he swallowed hard, his throat visibly working. “When she was, she never wanted to hear.”

McCoy’s gut clenched. So, his suspicions were right, damnit. There was something to tell.

“Maybe she’s ready to listen now.”

“Maybe I’m not,” he said shortly, then immediately caught himself. “Anyway, I don’t like talking about it.”

“I gathered.”

Jim shrugged. “Talking about it doesn’t change anything. It happened. It’s over and done. The past can’t be changed.”

“That’s the problem, Jim. Everything in your head, the way you’re feeling, is exactly the way it was when you were a child, and your mother wasn’t listening. All your memories and emotions are stuck there. You haven’t updated them, examined them through an adult’s perspective.”

Jim looked at him and something flickered in his gaze. Encouraged that he had Jim’s attention, McCoy felt his way forward.

“You’re in Starfleet now, Jim. Not roaming around Iowa on the back of your bike looking for the next bar fight because you’re angry and resentful, and you just want someone to pay attention to you, even if it’s just to punch you in the mouth. You’re at the top of your class, breaking records at the Academy. What I’m trying to say is, you’re not a little kid anymore with no options. You’re your own man.” He offered Jim a gentle smile. “And you’re my friend. My best friend. I’m always going to listen to you, Jim, and I’m always going to have your back.”

Jim’s blue eyes grew overly-bright and he looked away, blinking. McCoy held his breath. Jim didn’t know what to do with this piece of information. Hope? Trust? But something told McCoy it was a little more like ‘too good to be true.’

“You don’t have to get all gushy about it, Bones,” Jim said.

McCoy grinned. “I wouldn’t have to if you’d listen, dumbass.”

Jim smiled softly but didn’t look at McCoy. After a moment, his smile faded. “My mother… I don’t know how to just pretend nothing happened, Bones, talk to her like she’s been this great mother, and everything is fine. I just can’t do it.”

“I’m not suggesting you pretend nothing happened, Jim. That’s not fair to you. I’m saying talk to her, find out why she’s calling.”

Jim bit his lip, deep in thought. “Wh— what would I say? How would I begin?”

McCoy looked at him with compassion and understanding. “You could start by assuming she’s been telling the truth about the reason behind her calls. Tell her that you’re all right and that with time, you’ll make a full recovery.”

Jim slowly looked away. “I don’t know why she cares now. She never cared before.”

And that, McCoy decided, was the crux of the problem. Jim had decided long ago that his mother didn’t love him. “Maybe she didn’t know how to show you, kid. Or couldn’t, given what happened. Maybe she’ll never be able to do that the way you want her to. Take it from me, there’s some things you can’t change. You just find ways to accept them and move on.”

McCoy didn’t know if his words comforted Jim or not. The young man said nothing more, but he didn’t argue or leave, which was a hopeful sign. McCoy remained with him, silently offering his support, until an hour later, Jim finally stood and walked back to the bedroom.

* * *

Jim stared at the terminal. A polite message blinked on the small screen: Please stand by. The call had been put through to the _Lexington_ using the special link Pike had sent him. The comm was making its slow way through the complexities of the galactic network, traveling from one solar system to the next until _Lexington’s_ communications tech picked it up. From there, it would be sent to his mother’s private comm.

He rubbed his sweaty palms on his thighs. What would she think when she received it?

He looked past the terminal to the window next to Bones’ desk. The sun was setting in San Francisco, coloring the sky behind the campus buildings in a brilliant palette of shades of crimson. Which, Jim thought, was ironic and fitting. A bloodred sunset to mark all the open wounds and spilled blood between them. He hadn’t spoken to her in years. He’d left when he was sixteen and he hadn’t looked back. Not much anyway. He certainly hadn’t notified her when he’d joined Starfleet, not that it mattered. Pike obviously had her on a direct link and, it seemed clear, willingly gave her timely reports.

Why wasn’t that enough?

The terminal blinked: Communication Accepted

The _Lexington_ had accepted the comm. He ran his tongue over his lips. His mouth was dry, and he realized he was nervous. He didn’t know what he was going to say to her, and he realized now, when it was too late, that he should have planned this better.

He looked around the dorm. Bones had conveniently left on an errand, giving him privacy. But he felt the oppressive solitude of the room and the absence of his friend and wished that Bones had stayed. Bones had a way of making everything right. His breathing calmed. Whatever happened, Bones would understand.

He didn’t know how he was going to react when he saw her. Would the anger he’d harbored for years come spilling out? Did she have any idea of the damage she’d caused, the hurt and pain and loss she’d set into motion with her absence, physically and mentally?

The screen suddenly changed, and the image of his mother slowly filled the screen, faded at first, then growing crisper and more colorful, until she was just… there. Still in uniform, her hair was swept up off her collar, neat and tidy, as required by Starfleet regs. She looked… different. Older and more worn. Thinner. Her eyes were still the blue he remembered, though, although lines fanned out from the corners of them. People used to say they looked alike. But he couldn’t see it. Time had worn away the surface similarities.

“Jim,” she said quietly. “You look— You look well.”

“Mom.”

THE END

* * *

**Authors notes:** This is my first Academy fic. I wanted to explore Bones' first time handling Jim's allergic reaction early in their relationship. Our position with Winona is that she is damaged. She doesn't hate Jim. She did the best she could at the time, and now wants to repair the relationship with an adult Jim. But Jim's not quite ready to forgive and forget ... but he'll get there. DiamondBlue4 and I had tons of fun with this and we hope you enjoyed our exploration. As always, thank you for taking this journey with us.


End file.
